Provider Demographics
NPI:1770208613
Name:AUGUSTE, DEBORAH (INTERN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:AUGUSTE
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:GERALDE
Other - Middle Name:
Other - Last Name:AUGUSTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2514 HOLLINDALE LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7317
Mailing Address - Country:US
Mailing Address - Phone:678-232-3150
Mailing Address - Fax:
Practice Address - Street 1:240 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7214
Practice Address - Country:US
Practice Address - Phone:770-728-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program