Provider Demographics
NPI:1235275132
Name:AUGUSTINE, JAMES JEROME (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JEROME
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1753 EMORY RIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2589
Mailing Address - Country:US
Mailing Address - Phone:404-486-1157
Mailing Address - Fax:404-486-0346
Practice Address - Street 1:1753 EMORY RIDGE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2589
Practice Address - Country:US
Practice Address - Phone:404-486-1157
Practice Address - Fax:404-486-0346
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50643207P00000X
GA50125207P00000X
AZ31717207P00000X
CT42416207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE24923Medicare UPIN