WACHOVIA CHANTA' BANKS

BLYTHEWOOD, SC
NPI1487880126
Former NameWACHOVIA CHANTA' RIER
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: LA  COVID19-TMP-211)
Additional Taxonomies207P00000X Emergency Medicine
(Licence: PA  OT013286)
207Q00000X Family Medicine
(Licence: SC  51870)
208D00000X General Practice
(Licence: PA  OT013286)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2009-06-09
Last Update Date2022-01-06
Business Address
Dr. WACHOVIA CHANTA' BANKS D.O.
1175 GREY PINE DR
BLYTHEWOOD, SC 29016-7320
Phone number: 803-995-5599
Mailing Address
Dr. WACHOVIA CHANTA' BANKS D.O.
5800 BRUNSWICK CT
NEW ORLEANS, LA 70131-5425
Phone number: 717-880-3740
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