| NPI | 1972021483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE J TEASLEY Owner 843-801-8011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 207VG0400X Obstetrics & Gynecology, Gynecology | |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2023-12-11 |