Provider Demographics
NPI:1417260902
Name:AUGUSTA MD, P.C.
Entity Type:Organization
Organization Name:AUGUSTA MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-364-3965
Mailing Address - Street 1:PO BOX 14638
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-0638
Mailing Address - Country:US
Mailing Address - Phone:706-364-3965
Mailing Address - Fax:706-504-3263
Practice Address - Street 1:2608 COMMONS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2080
Practice Address - Country:US
Practice Address - Phone:706-364-3965
Practice Address - Fax:706-504-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0216382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDJNLMedicare PIN
GAD39349Medicare UPIN