| NPI | 1114117488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT RUSSELL NICOL Business Manager 843-353-0288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 14684) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 30634) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: SC 14684) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2012-05-17 |