Provider Demographics
NPI: | 1760559124 |
---|---|
Name: | AUGUSTA UNIVERSITY |
Entity Type: | Organization |
Organization Name: | AUGUSTA UNIVERSITY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DELEGATED OFFICAL |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CONNIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | THOMPSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 706-721-5505 |
Mailing Address - Street 1: | 1499 WALTON WAY |
Mailing Address - Street 2: | STE 1400 |
Mailing Address - City: | AUGUSTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30901-2602 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 706-721-6597 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1120 15TH ST |
Practice Address - Street 2: | |
Practice Address - City: | AUGUSTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30912-0004 |
Practice Address - Country: | US |
Practice Address - Phone: | 706-721-6597 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-29 |
Last Update Date: | 2019-12-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | HOSP215 | Medicare ID - Type Unspecified |