Provider Demographics
NPI:1043267222
Name:AUGUSTUS, CARL TRENT (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:TRENT
Last Name:AUGUSTUS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 E WT HARRIS BLVD
Mailing Address - Street 2:SUITE P311
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4104
Mailing Address - Country:US
Mailing Address - Phone:704-510-9481
Mailing Address - Fax:704-510-9758
Practice Address - Street 1:8426 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9746
Practice Address - Country:US
Practice Address - Phone:704-510-9581
Practice Address - Fax:704-510-9758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC9691218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912392Medicaid
NCG35076Medicare UPIN
NC8912392Medicaid