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General NPI Number Information
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NPI Number | 1699733956
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Entity Type | Individual
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Provider Name | PEGGY H AUGUSTINE DDS
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3645 GENTIAN BLVD SUITE 2
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City | COLUMBUS
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State | GA
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Zip | 31907-5687
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Country | US
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Telephone | 706-660-0221
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Fax | 706-660-0132
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Provider Business Mailing Address
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Address Line | 5630 ROARING BRANCH RD
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City | COLUMBUS
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State | GA
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Zip | 31904-2832
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Country | US
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Telephone | 706-321-8717
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 012299
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License Number State | GA
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