| NPI | 1902047277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN ARTIOLI Credentialing Specialist 843-234-6946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health |
| 363LF0000X Nurse Practitioner Family | |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2024-08-23 |