| NPI | 1366567778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MCKAY Office Manger 843-669-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: SC 11313) |
| Additional Taxonomies | 111NR0400X (Licence: SC 2474) |
| 111NR0400X (Licence: SC 3406) | |
| 207Q00000X Family Medicine (Licence: SC 11313) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: SC 6253900001) | |
| 363A00000X Physician Assistant (Licence: SC 1091) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2015-02-09 |