| NPI | 1902673130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHANNA L HAYNES CEO 843-234-8220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2024-12-19 |