| NPI | 1598742041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD W TICE Managing Physician 843-215-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 0364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 0584) |
| 207Q00000X Family Medicine (Licence: SC 0708) | |
| 207Q00000X Family Medicine (Licence: SC DO1072) | |
| 207Q00000X Family Medicine (Licence: SC 0847) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2008-04-20 |