MEDICARE: JAMES JEROME AUGUSTINE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	50643	OH
2	207P00000X	Emergency Medicine Physician	50125	GA
3	207P00000X	Emergency Medicine Physician	31717	AZ
4	207P00000X	Emergency Medicine Physician	42416	CT

General Provider Information

NPI Number	:	1235275132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES JEROME AUGUSTINE MD

Provider Business Mailing Address
First Line	:	1753 EMORY RIDGE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2589
Country	:	US
Telephone Number	:	404-486-1157
Fax Number	:	404-486-0346

Provider Business Practice Location Address
First Line	:	1753 EMORY RIDGE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2589
Country	:	US
Telephone Number	:	404-486-1157
Fax Number	:	404-486-0346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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