Healthcare Provider Details

I. General information

NPI: 1437279122
Provider Name (Legal Business Name): AUGUSTINE HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 GATEWAY CORPORATE BLVD SUITE 230
COLUMBIA SC
29203-9740
US

IV. Provider business mailing address

PO BOX 601964
CHARLOTTE NC
28260-1964
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-2277
  • Fax: 803-788-6508
Mailing address:
  • Phone: 855-477-2477
  • Fax: 216-472-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA HAITHCOCK
Title or Position: PROJECT MANAGER
Credential:
Phone: 803-865-4780