Healthcare Provider Details

I. General information

NPI: 1881528214
Provider Name (Legal Business Name): MR. AUGUST CHRISTIAN TALIAFERRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N WASHINGTON HWY STE 9
ASHLAND VA
23005-1623
US

IV. Provider business mailing address

806 BROOK HILL RD APT 423
RICHMOND VA
23227-2509
US

V. Phone/Fax

Practice location:
  • Phone: 804-982-9505
  • Fax:
Mailing address:
  • Phone: 804-982-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019013279
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: