Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Other names
Providence Northeast Family Care at Lake Carolina
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY W WHITAKER CPC (MANAGER)
(803) 865-4798
Entity
Organization
Contact information
Practice address
300 LONG POINTE LN, SUITE 130, COLUMBIA, SC 29229-7543
(803) 462-7193
(803) 462-7163
Mailing address
PO BOX 60496, CHARLOTTE, NC 28260-0496
(803) 462-7193
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4545
—
SC
Enumeration date
03/29/2007
Last updated
03/07/2008
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