Healthcare Provider Details

I. General information

NPI: 1497679542
Provider Name (Legal Business Name): BRUCE AUGUSTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 PANTHERSVILLE RD
DECATUR GA
30034-3828
US

IV. Provider business mailing address

3073 PANTHERSVILLE RD
DECATUR GA
30034-3828
US

V. Phone/Fax

Practice location:
  • Phone: 404-243-2230
  • Fax:
Mailing address:
  • Phone: 404-243-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH018296
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: