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Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Other names
Providence Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY W. WHITAKER CPC (MANAGER)
(803) 865-4798
Entity
Organization
Contact information
Practice address
1655 BERNARDIN AVE, SUITE 110, COLUMBIA, SC 29204-2039
(803) 254-4056
(803) 254-4120
Mailing address
PO BOX 60496, CHARLOTTE, NC 28260-0496
(803) 254-4056
(803) 254-4120
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4662
—
SC
Enumeration date
03/29/2007
Last updated
03/07/2008
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