| NPI | 1508623398 |
|---|---|
| Doing Business As | MEDICAL PLAZA FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | SAMUEL FULTON ERVIN Sr. VP & CFO 843-777-2910 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2024-02-28 |