Provider Demographics
NPI:1659331668
Name:AUGUST, GARRY LEWIS (MD)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:LEWIS
Last Name:AUGUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 13TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1908
Mailing Address - Country:US
Mailing Address - Phone:706-322-4486
Mailing Address - Fax:706-322-4403
Practice Address - Street 1:1519 13TH AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1908
Practice Address - Country:US
Practice Address - Phone:706-322-4486
Practice Address - Fax:706-322-4403
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18360207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00137508DMedicaid
GA00137508DMedicaid
46BBBFGMedicare ID - Type Unspecified