| NPI | 1609273549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STELA SUSAC-PAVIC Md/Owner 843-501-2031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: SC SC35609) |
| 315D00000X Hospice, Inpatient (Licence: SC SC35609) | |
| 363AM0700X Physician Assistant, Medical (Licence: SC SC1314) | |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2024-01-23 |