Provider Demographics
NPI:1033224506
Name:AUGUSTUS, VALERIE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:LOUISE
Last Name:AUGUSTUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 WEST ST
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3830
Mailing Address - Country:US
Mailing Address - Phone:901-372-0914
Mailing Address - Fax:901-372-9723
Practice Address - Street 1:2205 WEST ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3830
Practice Address - Country:US
Practice Address - Phone:901-372-0914
Practice Address - Fax:901-372-9723
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD282982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF96930Medicare UPIN
TN3723213Medicare ID - Type Unspecified