| NPI | 1831435429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE KNIGHT DISHER Credentialing Manager 803-773-5227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine |
| 207Q00000X Family Medicine | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2012-12-31 |
| Last Update Date | 2025-01-30 |