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Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Other names
Providence Northeast Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA HAITHCOCK (PROJECT MANAGER)
(803) 865-4780
Entity
Organization
Contact information
Practice address
114 GATEWAY CORPORATE BLVD, SUITE 230, COLUMBIA, SC 29203-9740
(803) 788-2277
(803) 788-6508
Mailing address
PO BOX 601964, CHARLOTTE, NC 28260-1964
(855) 477-2477
(216) 472-2740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4383
—
SC
Enumeration date
03/29/2007
Last updated
02/06/2012
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