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General NPI Number Information
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NPI Number | 1619279544
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Entity Type | Organization
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Legal Business Name | AUGUSTA FAMILY MEDICAL SERVICE
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 1500 JOHNS RD SUITE # 2
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City | AUGUSTA
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State | GA
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Zip | 30904-4888
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Country | US
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Telephone | 706-736-3688
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Fax | 706-736-3628
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Provider Business Mailing Address
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Address Line | 1500 JOHNS RD SUITE # 2
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City | AUGUSTA
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State | GA
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Zip | 30904-4888
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Country | US
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Telephone | 706-736-3688
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Fax | 706-736-3628
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Authorized Official
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Title or Position | OWNER
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Name | DR. ABEBE KASSAHUN
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Credential | M.D
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Telephone | 706-736-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 063248
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License Number State | GA
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