Healthcare Provider Details

I. General information

NPI: 1619209905
Provider Name (Legal Business Name): AUGUSTA MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3642 WHEELER RD
AUGUSTA GA
30909-6519
US

IV. Provider business mailing address

3642 WHEELER RD
AUGUSTA GA
30909-6519
US

V. Phone/Fax

Practice location:
  • Phone: 706-496-2573
  • Fax: 706-496-2637
Mailing address:
  • Phone: 706-496-2573
  • Fax: 706-496-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58109
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number58109
License Number StateGA

VIII. Authorized Official

Name: DR. KASHIF NASEEM
Title or Position: PRESIDENT
Credential: MD
Phone: 706-496-2573