| NPI | 1316540636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES M PROCTOR Director 843-488-1895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2021-07-14 |