Provider Demographics
NPI:1538114772
Name:AUGUST, TIMOTHY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:AUGUST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-8511
Mailing Address - Country:US
Mailing Address - Phone:828-631-1852
Mailing Address - Fax:828-631-2534
Practice Address - Street 1:61 BONNIE LN
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-8511
Practice Address - Country:US
Practice Address - Phone:828-631-1852
Practice Address - Fax:828-586-8209
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02037363A00000X
FLPA9101858363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS88081Medicare UPIN