Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Other names
Providence Women's Health
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA S HAITHCOCK (PROJECT MANAGER)
(803) 865-4780
Entity
Organization
Contact information
Practice address
114 GATEWAY CORPORATE BLVD, SUITE 350, COLUMBIA, SC 29203-9740
(803) 788-0268
(803) 788-7384
Mailing address
PO BOX 601964, CHARLOTTE, NC 28260-1964
(855) 477-2477
(216) 472-2740
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
21388
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4125
—
SC
Enumeration date
03/30/2007
Last updated
02/01/2012
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