Provider Demographics
NPI:1972743383
Name:AUGUSTA INPATIENT SERVICES, LLC
Entity type:Organization
Organization Name:AUGUSTA INPATIENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:3623 J DEWEY GRAY CIR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6511
Mailing Address - Country:US
Mailing Address - Phone:706-855-0422
Mailing Address - Fax:706-855-0495
Practice Address - Street 1:3623 J DEWEY GRAY CIR
Practice Address - Street 2:SUITE 113
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6511
Practice Address - Country:US
Practice Address - Phone:706-855-0422
Practice Address - Fax:706-855-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA672340027AMedicaid
GADF7769OtherRR MEDICARE
GA672340027AMedicaid