Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Other names
Providence Family Medicine Dutchfork
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY A MOWRER (CREDENTIALING SPECIALIST)
(216) 472-2741
Entity
Organization
Contact information
Practice address
110 DUTCHMAN BLVD, IRMO, SC 29063-8330
(803) 732-8370
(803) 732-8373
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
Enumeration date
11/06/2013
Last updated
11/06/2013
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