Healthcare Provider Details

I. General information

NPI: 1396918637
Provider Name (Legal Business Name): AUGUSTUS MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E WT HARRIS BLVD SUITE P311
CHARLOTTE NC
28213-4104
US

IV. Provider business mailing address

1001 E WT HARRIS BLVD SUITE P311
CHARLOTTE NC
28213-4104
US

V. Phone/Fax

Practice location:
  • Phone: 704-510-9481
  • Fax: 704-510-9758
Mailing address:
  • Phone: 704-510-9481
  • Fax: 704-510-9758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number9601218
License Number StateNC

VIII. Authorized Official

Name: DR. CARL TRENT AUGUSTUS
Title or Position: PRESIDENT
Credential: MD
Phone: 704-510-9481