Provider Demographics
NPI:1740255041
Name:AUGUSTIN, NERVA (MD)
Entity type:Individual
Prefix:
First Name:NERVA
Middle Name:
Last Name:AUGUSTIN
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 1:6020 MORGANTON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1352
Mailing Address - Country:US
Mailing Address - Phone:910-764-4750
Mailing Address - Fax:910-764-4752
Practice Address - Street 1:6020 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1352
Practice Address - Country:US
Practice Address - Phone:910-764-4750
Practice Address - Fax:910-764-4752
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR158962084P0800X
NC2006017742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry