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Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Other names
Jack H. Gottlieb, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGELA HAITHCOCK (PROJECT MANAGER)
(803) 865-4780
Entity
Organization
Contact information
Practice address
2601 LAUREL ST, SUITE 120, COLUMBIA, SC 29204-2033
(803) 254-7889
(803) 254-7893
Mailing address
114 GATEWAY CORPORATE BLVD, SUITE 425, COLUMBIA, SC 29203-9740
(803) 865-4780
(803) 865-4932
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5205
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052052
—
SC
Enumeration date
07/28/2010
Last updated
02/06/2012
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