MEDICARE: AUGUSTINE HEALTH GROUP, LLC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750401451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUGUSTINE HEALTH GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 60496
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0496
Country	:	US
Telephone Number	:	803-462-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 LONG POINTE LN
Second Line	:	SUITE 130
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7543
Country	:	US
Telephone Number	:	803-462-7193
Fax Number	:	803-462-7163

Authorized Official
Title or Position	:	MANAGER
Name	:	JEREMY W WHITAKER
Credential	:	CPC
Telephone Number	:	803-865-4798

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	03/07/2008

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Directions to “AUGUSTINE HEALTH GROUP, LLC ” Practice Location

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