Provider Demographics
NPI:1275347262
Name:AUGUSTUS, JOHN C JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:AUGUSTUS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 S BREVARD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-0939
Mailing Address - Country:US
Mailing Address - Phone:904-204-7369
Mailing Address - Fax:
Practice Address - Street 1:1155 S BREVARD ST
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-0939
Practice Address - Country:US
Practice Address - Phone:904-204-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL19000285187343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)