Provider Demographics
NPI:1245489590
Name:AUGUSTA MEDICAL GROUP
Entity type:Organization
Organization Name:AUGUSTA MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FACHE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MANNIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-932-4000
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5162
Mailing Address - Fax:540-932-4616
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-932-5162
Practice Address - Fax:540-932-4616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUGUSTA HEALTH CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-11
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1100Medicare PIN