Provider Demographics
NPI:1184680381
Name:AUGUSTUS, CHARLES ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDERSON
Last Name:AUGUSTUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N KROME AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4443
Mailing Address - Country:US
Mailing Address - Phone:305-245-1611
Mailing Address - Fax:305-245-8898
Practice Address - Street 1:950 N KROME AVE STE 403
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4443
Practice Address - Country:US
Practice Address - Phone:305-245-1611
Practice Address - Fax:305-245-8898
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 42610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054130300Medicaid
FL12156Medicare ID - Type Unspecified
FL054130300Medicaid