Healthcare Provider Details

I. General information

NPI: 1033716915
Provider Name (Legal Business Name): AU MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 SAINT SEBASTIAN WAY STE 402
AUGUSTA GA
30901-2654
US

IV. Provider business mailing address

1120 15TH ST # BT2601
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-4245
  • Fax:
Mailing address:
  • Phone: 803-522-4350
  • Fax: 706-721-9505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RASHAD DARBY
Title or Position: MANAGER-COMMUNITY PHARMACY
Credential:
Phone: 803-522-4350