# AUGUSTINE HEALTH GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jack H. Gottlieb, M.D.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780998161
- **Authorized official:** MS. ANGELA HAITHCOCK (PROJECT MANAGER)
- **Authorized official phone:** (803) 865-4780

## Contact information

- **Practice address:** 2601 LAUREL ST, SUITE 120, COLUMBIA, SC 29204-2033
- **Practice address phone:** (803) 254-7889
- **Practice address fax:** (803) 254-7893
- **Mailing address:** 114 GATEWAY CORPORATE BLVD, SUITE 425, COLUMBIA, SC 29203-9740
- **Mailing address phone:** (803) 865-4780
- **Mailing address fax:** (803) 865-4932

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 5205 | SC | Yes |

## Other

- **Enumeration date:** 07/28/2010
- **Last updated:** 02/06/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 052052 | — | SC |