Healthcare Provider Details

I. General information

NPI: 1972612190
Provider Name (Legal Business Name): JACK H AUSTIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 WALTON WAY
AUGUSTA GA
30904-2305
US

IV. Provider business mailing address

811 13TH STREET SUITE 10
AUGUSTA GA
30901
US

V. Phone/Fax

Practice location:
  • Phone: 706-434-1590
  • Fax:
Mailing address:
  • Phone: 706-434-1590
  • Fax: 706-434-1595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number032689
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: