Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Other names
Providence Psychiatric Consults
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY W. WHITAKER (MANAGER)
(806) 865-4798
Entity
Organization
Contact information
Practice address
114 GATEWAY CORPORATE BLVD, SUITE 425, COLUMBIA, SC 29203-9740
(803) 256-5300
Mailing address
PO BOX 60496, CHARLOTTE, NC 28260-0496
(803) 256-5300
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
Primary
19523
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4739
—
SC
Enumeration date
06/22/2007
Last updated
04/29/2008
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