Provider Demographics
NPI:1003925223
Name:JACK H. AUSTIN, JR., MD, PC
Entity Type:Organization
Organization Name:JACK H. AUSTIN, JR., MD, PC
Other - Org Name:INFECTIOUS DISEASE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-724-4376
Mailing Address - Street 1:P.O. BOX 3429
Mailing Address - Street 2:1125 TROUPE STREET
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3429
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:820 ST. SEBASTIAN WAY
Practice Address - Street 2:SUITE 4A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-724-4376
Practice Address - Fax:706-731-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972612190OtherNPI - JACK H. AUSTIN
SCGPA850Medicaid
SCGPA850Medicaid