| NPI | 1902150832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY K INGRAM Billing Manager 803-547-4343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2014-03-03 |