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General NPI Number Information
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NPI Number | 1699198614
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Entity Type | Individual
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Provider Name | JIMMY AUGUSTIN
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Gender | Male
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 4300 HAREWOOD RD NE
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City | WASHINGTON
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State | DC
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Zip | 20017-1513
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Country | US
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Telephone | 202-529-0900
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Fax | 202-526-8879
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Provider Business Mailing Address
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Address Line | 11517 AQUARIUS COURT
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City | FORT WASHINGTON
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State | MD
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Zip | 20744
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Country | US
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Telephone | 240-603-1291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000006834
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License Number State | DC
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