# AUGUSTINE HEALTH GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Internal Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518087287
- **Authorized official:** MR. JEREMY W. WHITAKER CPC (MANAGER)
- **Authorized official phone:** (803) 865-4798

## Contact information

- **Practice address:** 1655 BERNARDIN AVE, SUITE 110, COLUMBIA, SC 29204-2039
- **Practice address phone:** (803) 254-4056
- **Practice address fax:** (803) 254-4120
- **Mailing address:** PO BOX 60496, CHARLOTTE, NC 28260-0496
- **Mailing address phone:** (803) 254-4056
- **Mailing address fax:** (803) 254-4120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 03/07/2008