| NPI | 1265426167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH D SHEALY Owner 803-285-7414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 2674) |
| 363L00000X Nurse Practitioner (Licence: SC 20303) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2023-10-10 |