| NPI | 1689869018 |
|---|---|
| Doing Business As | MCLEOD FAMILY MEDICINE - LATTA |
| Entity Type | Organization |
| Authorized Contact | PAUL PROVENZANO Regional Practice Manager/A VP 843-777-7030 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2009-03-27 |