Basic Information
| Provider Information | |||||||||
| NPI: | 1235512369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUGUSTINE | ||||||||
| FirstName: | NIDA | ||||||||
| MiddleName: | RAUF | ||||||||
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| Credential: | DO | ||||||||
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| OtherLastName: | RAUF | ||||||||
| OtherFirstName: | NIDA | ||||||||
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| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1120 15TH ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120004 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1638 OWEN DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106155610 | ||||||||
| FaxNumber: | 9106155080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7684 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2018-01567 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.