Provider Demographics
NPI:1306933866
Name:AUGUSTA ASSOCIATES INT MED&RH
Entity type:Organization
Organization Name:AUGUSTA ASSOCIATES INT MED&RH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-792-0948
Mailing Address - Street 1:2361 TOBACCO RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-9220
Mailing Address - Country:US
Mailing Address - Phone:706-793-4401
Mailing Address - Fax:706-792-0948
Practice Address - Street 1:2361 TOBACCO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-9220
Practice Address - Country:US
Practice Address - Phone:706-793-4401
Practice Address - Fax:706-792-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4712Medicare ID - Type UnspecifiedGROUP NUMBER