Augusta Anti-Aging Medicine, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

AUGUSTA ANTI-AGING MEDICINE, LLC

Practice address

610 Ponder Place Dr
Evans, GA 30809-3185

Phone

(706) 707-2808

NPI assigned

Mar 17, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samantha S Tojino, DNP, FNP-CNPI 1164861274

Title

Single Member

Phone

(706) 707-2808

Specialties & licenses 1

Addresses

Other names 1

• Augusta Anti-Aging Medicine, LLC Former legal business name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samantha Shoemaker Tojino, FNP

  • Adult Health Nurse Practitioner
  • Evans, GA
  • NPI 1164861274

  Family

  Medicare reassignment Care Compare group NPD Authorized official
• Shannon Leigh Whitwell, FNP

  • Family Nurse Practitioner
  • Martinez, GA
  • NPI 1437619277
  Medicare reassignment Care Compare group NPD
• Teresa Annette Watts, DNP, FNP-C

  • Family Nurse Practitioner
  • Evans, GA
  • NPI 1467963090
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615939200000",
    "number": "1568047876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 PONDER PLACE DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093185",
            "telephone_number": "706-707-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 PONDER PLACE DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093185",
            "telephone_number": "706-707-2808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "605 Medinah Dr",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309079430",
            "country_code": "US",
            "telephone_number": "706-707-2808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AUGUSTA ANTI-AGING MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A",
        "authorized_official_last_name": "TOJINO",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SINGLE MEMBER",
        "authorized_official_telephone_number": "706-707-2808",
        "authorized_official_credential": "DNP, FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Evans",
            "affiliation": "N",
            "endpointDescription": "Menopausal, Sexual, and Pelvic Health",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "610 Ponder Place Dr",
            "city": "Evans",
            "state": "GA",
            "country_code": "US",
            "postal_code": "308093185",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Augusta Anti-Aging Medicine, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Army
• Lawrence Eugene Arrington, M.D.
• Brian Athearn, LDO
• Destanee Atwell
• Augusta Allergy and Asthma, LLC
• Augusta Center for Cognitive Behavior Therapy LLC
• Augusta Endoscopy Center, LLC.
• Augusta ENT PC
• Augusta Foot & Ankle, PC
• Augusta Foot & Ankle, PC

• Family Nurse Practitioner in Evans, GA
• Providers in Evans, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.