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General NPI Number Information
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NPI Number | 1518087287
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Entity Type | Organization
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Legal Business Name | AUGUSTINE HEALTH GROUP, LLC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 1655 BERNARDIN AVE SUITE 110
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City | COLUMBIA
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State | SC
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Zip | 29204-2039
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Country | US
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Telephone | 803-254-4056
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Fax | 803-254-4120
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Provider Business Mailing Address
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Address Line | PO BOX 60496
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City | CHARLOTTE
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State | NC
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Zip | 28260-0496
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Country | US
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Telephone | 803-254-4056
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Fax | 803-254-4120
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JEREMY W. WHITAKER
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Credential | CPC
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Telephone | 803-865-4798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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