Provider Demographics
NPI:1659573988
Name:CONDUAH, AUGUSTINE H (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:H
Last Name:CONDUAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8225 MALL PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6994
Mailing Address - Country:US
Mailing Address - Phone:770-482-3241
Mailing Address - Fax:770-482-3243
Practice Address - Street 1:8225 MALL PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6994
Practice Address - Country:US
Practice Address - Phone:770-482-3241
Practice Address - Fax:770-482-3243
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.28762207X00000X
CAA86976207XX0005X
GA60818207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I200049Medicare PIN
AL510I200033Medicare PIN