| NPI | 1386163392 |
|---|---|
| Doing Business As | PRIMARY CARE AT HOME OF CHARLESTON |
| Entity Type | Organization |
| Authorized Contact | DONALD D. STELLY President 337-233-1307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2017-09-12 |