| NPI | 1962183657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORTNEY SHANTRES ELLIS Authorized Official 864-356-4598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2023-07-26 |