Provider Demographics
NPI:1497947261
Name:PIEDMONT INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:PIEDMONT INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:T
Authorized Official - Last Name:AUGOUSTIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-760-0240
Mailing Address - Street 1:1411 PLAZA WEST DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1482
Mailing Address - Country:US
Mailing Address - Phone:336-760-0240
Mailing Address - Fax:336-760-4568
Practice Address - Street 1:1411 PLAZA WEST DR
Practice Address - Street 2:SUITE B
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1482
Practice Address - Country:US
Practice Address - Phone:336-760-0240
Practice Address - Fax:336-760-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36139261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2339957OtherMEDICARE GROUP NUMBER
NC2339957OtherMEDICARE GROUP NUMBER