1740837756 NPI number — AU MEDICAL ASSOCIATES INC

Table of content: (NPI 1740837756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740837756 NPI number — AU MEDICAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AU MEDICAL ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AU MEDICAL CENTER CLINICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740837756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1499 WALTON WAY STE 1400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30901-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-724-6100
Provider Business Mailing Address Fax Number:
706-724-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1447 HARPER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30912-0020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-721-8623
Provider Business Practice Location Address Fax Number:
706-721-1459
Provider Enumeration Date:
08/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
706-721-5505

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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