Healthcare Provider Details

I. General information

NPI: 1184095036
Provider Name (Legal Business Name): TIMOTHY AUGUSTINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 DECATUR PIKE
ATHENS TN
37303-3038
US

IV. Provider business mailing address

928 DECATUR PIKE
ATHENS TN
37303-3038
US

V. Phone/Fax

Practice location:
  • Phone: 423-745-5420
  • Fax: 401-770-7108
Mailing address:
  • Phone: 423-745-5420
  • Fax: 401-770-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10202
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: