| NPI | 1366191702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN ARTIOLI Credentialing Specialist 843-234-6946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 363LF0000X Nurse Practitioner Family | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery | |
| 207ND0900X Dermatology Dermatopathology | |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2024-06-26 |