Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Other names
Jack H. Gottlieb, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGELA HAITHCOCK (PROJECT MANAGER)
(803) 865-4780
Entity
Organization
Contact information
Practice address
2601 LAUREL ST, SUITE 120, COLUMBIA, SC 29204-2033
(803) 254-7889
(803) 254-7893
Mailing address
114 GATEWAY CORPORATE BLVD, SUITE 425, COLUMBIA, SC 29203-9740
(803) 865-4780
(803) 865-4932
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5205
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052052
—
SC
Enumeration date
07/28/2010
Last updated
02/06/2012
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