Provider Demographics
NPI:1730865619
Name:AUGUST UNIVERSITY - MEDICAL COLLEGE OF GEORGIA
Entity type:Organization
Organization Name:AUGUST UNIVERSITY - MEDICAL COLLEGE OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN/STAFF
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-729-1791
Mailing Address - Street 1:1480 WRIGHTSBORO RD UNIT 2201
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:954-729-1791
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH STREET BL 5070
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:706-721-2423
Practice Address - Fax:706-721-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty