Provider Demographics
NPI:1447541446
Name:JOSEPH AUGUSTIN MD LLC
Entity type:Organization
Organization Name:JOSEPH AUGUSTIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTIN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-975-5274
Mailing Address - Street 1:PO BOX 9234
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-9234
Mailing Address - Country:US
Mailing Address - Phone:504-975-5274
Mailing Address - Fax:770-953-8132
Practice Address - Street 1:3540 WHEELER RD
Practice Address - Street 2:SUITE 508
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1871
Practice Address - Country:US
Practice Address - Phone:504-975-5274
Practice Address - Fax:770-953-4864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA650822081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty