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NPI Code Detail

MEDICARE: AUGUSTUS MEDICAL PC

MEDICARE: AUGUSTUS MEDICAL PC
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
1261QP2300XPrimary Care Clinic/Center9601218NC

General Provider Information

NPI Number : 1396918637
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUGUSTUS MEDICAL PC
Provider Business Mailing Address
First Line : 1001 E WT HARRIS BLVD
Second Line : SUITE P311
City : CHARLOTTE
State : NC
Zip : 28213-4104
Country : US
Telephone Number : 704-510-9481
Fax Number : 704-510-9758
Provider Business Practice Location Address
First Line : 1001 E WT HARRIS BLVD
Second Line : SUITE P311
City : CHARLOTTE
State : NC
Zip : 28213-4104
Country : US
Telephone Number : 704-510-9481
Fax Number : 704-510-9758
Authorized Official
Title or Position : PRESIDENT
Name : DR. CARL TRENT AUGUSTUS
Credential : MD
Telephone Number : 704-510-9481
Provider Enumeration Date : 04/08/2008
Last Update Date : 04/08/2008

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Directions to “AUGUSTUS MEDICAL PC ” Practice Location

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