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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