Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Other names
Providence EKG Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY W WHITAKER CPC (MANAGER)
(803) 865-4798
Entity
Organization
Contact information
Practice address
120 GATEWAY CORPORATE BLVD, COLUMBIA, SC 29203-9611
(803) 256-5460
Mailing address
PO BOX 60496, CHARLOTTE, NC 28260-0496
(803) 256-5460
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4709
—
SC
Enumeration date
06/13/2007
Last updated
04/29/2008
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