Provider Demographics
NPI:1386287464
Name:GLAYGBE, AUGUSTINE W SR
Entity type:Individual
Prefix:MR
First Name:AUGUSTINE
Middle Name:W
Last Name:GLAYGBE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:AUGUSTINE
Other - Middle Name:
Other - Last Name:GLAYGBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANGEL'S TRANSPORT
Mailing Address - Street 1:9624 RAU CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5055
Mailing Address - Country:US
Mailing Address - Phone:704-492-3061
Mailing Address - Fax:
Practice Address - Street 1:9624 RAU CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5055
Practice Address - Country:US
Practice Address - Phone:704-492-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)