| NPI | 1417089376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELDA FIELDS Consultant 843-881-4440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 22169) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC 22169) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: SC 22169) | |
| 363A00000X Physician Assistant (Licence: SC 1048) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2009-10-21 |