| None | |
|
315 Haynsworth St Sumter SC 29150-4005 | |
| (803) 236-3958 | |
| Not Available |
| Full Name | None |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 315 Haynsworth St, Sumter, South Carolina |
| Authorized Official Name and Position | Auston H. Gray (PRESIDENT AND CEO) |
| Authorized Official Contact | 8032363199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 315 Haynsworth St Sumter SC 29150-4005 Ph: (803) 236-3958 | None 315 Haynsworth St Sumter SC 29150-4005 Ph: (803) 236-3958 |
| NPI Number | 1679589485 |
|---|---|
| Provider Enumeration Date | 08/01/2006 |
| Last Update Date | 10/25/2022 |
| Certification Date | 10/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679589485 | NPI | - | NPPES |
| GP3142 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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