Provider Demographics
NPI:1972858421
Name:AUGUSTA, JAMES WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:AUGUSTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 WASHINGTON VILLAGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3994
Mailing Address - Country:US
Mailing Address - Phone:937-439-4145
Mailing Address - Fax:937-439-4371
Practice Address - Street 1:7740 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4056
Practice Address - Country:US
Practice Address - Phone:937-439-4145
Practice Address - Fax:937-439-4371
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31-0564121390200000X
OH34012460208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program