Provider Demographics
NPI:1619209905
Name:AUGUSTA MEDICAL CARE LLC
Entity Type:Organization
Organization Name:AUGUSTA MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KASHIF
Authorized Official - Middle Name:
Authorized Official - Last Name:NASEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-496-2573
Mailing Address - Street 1:3642 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6519
Mailing Address - Country:US
Mailing Address - Phone:706-496-2573
Mailing Address - Fax:706-496-2637
Practice Address - Street 1:3642 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6519
Practice Address - Country:US
Practice Address - Phone:706-496-2573
Practice Address - Fax:706-496-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58109207Q00000X, 208D00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty