1003925223 NPI number — JACK H. AUSTIN, JR., MD, PC

Table of content: (NPI 1003925223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003925223 NPI number — JACK H. AUSTIN, JR., MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACK H. AUSTIN, JR., MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INFECTIOUS DISEASE CONSULTANTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003925223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 3429
Provider Second Line Business Mailing Address:
1125 TROUPE STREET
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30914-3429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-737-4575
Provider Business Mailing Address Fax Number:
706-731-5289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 ST. SEBASTIAN WAY
Provider Second Line Business Practice Location Address:
SUITE 4A
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-724-4376
Provider Business Practice Location Address Fax Number:
706-731-5289
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AUSTIN
Authorized Official First Name:
JACK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
706-724-4376

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1972612190 . This is a "NPI - JACK H. AUSTIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: GPA850 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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