| NPI | 1083693857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA K GRANT Office Manager 803-771-7506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207ND0900X Dermatology Dermatopathology | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2024-07-16 |