| NPI | 1366591703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRET JOHNSON CFO 843-724-2946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 22518) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: SC TL29749) |
| 207RG0300X Internal Medicine Geriatric Medicine (Licence: SC TL30258) | |
| 103G00000X Clinical Neuropsychologist (Licence: SC 000520) | |
| 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: SC 19311) | |
| 2086S0129X Surgery Vascular Surgery (Licence: SC 27482) | |
| 261QR0200X Clinic/Center Radiology | |
| 363L00000X Nurse Practitioner (Licence: SC APN2541) | |
| 363LN0000X Nurse Practitioner Neonatal (Licence: SC 00048029) | |
| 207R00000X Internal Medicine (Licence: SC 22489) | |
| 207XS0106X Orthopaedic Surgery Hand Surgery (Licence: SC 20903) | |
| 103G00000X Clinical Neuropsychologist (Licence: SC 520) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: SC 19281) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-01-14 |