Healthcare Provider Details

I. General information

NPI: 1407177652
Provider Name (Legal Business Name): AUSTIN LUKE SHIVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W WHEELER PKWY
AUGUSTA GA
30909-6625
US

IV. Provider business mailing address

1120 15TH ST # R2029
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2741
  • Fax:
Mailing address:
  • Phone: 706-721-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4239
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2024-00732
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number69639
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: