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General NPI Number Information
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NPI Number | 1740484658
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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 | 06/13/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 120 GATEWAY CORPORATE BLVD
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City | COLUMBIA
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State | SC
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Zip | 29203-9611
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Country | US
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Telephone | 803-256-5460
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Fax |
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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 | 803-256-5460
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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