1295904050 NPI number — DR. JOSEPH CHARLES AUGUSTIN M.D.

Table of content: DR. JOSEPH CHARLES AUGUSTIN M.D. (NPI 1295904050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295904050 NPI number — DR. JOSEPH CHARLES AUGUSTIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUGUSTIN
Provider First Name:
JOSEPH
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1295904050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-975-5274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 INDEPENDENCE DR
Provider Second Line Business Practice Location Address:
PHYSICIAN SUITE
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-722-1244
Provider Business Practice Location Address Fax Number:
706-722-6566
Provider Enumeration Date:
02/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  65082 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081P2900X , with the licence number: 200864 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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