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2323 Saint Matthews Rd Orangeburg SC 29118-2042 | |
| (803) 534-0042 | |
| (803) 531-0676 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2323 Saint Matthews Rd, Orangeburg, South Carolina |
| Authorized Official Name and Position | Kerry L Bourgeois (OFFICE MANAGER) |
| Authorized Official Contact | 8035340042 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 749 Orangeburg SC 29116-0749 Ph: (803) 534-0042 | 2323 Saint Matthews Rd Orangeburg SC 29118-2042 Ph: (803) 534-0042 |
| NPI Number | 1275732422 |
|---|---|
| Provider Enumeration Date | 07/17/2007 |
| Last Update Date | 11/07/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275732422 | NPI | - | NPPES |
| GP6287 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 15347 (South Carolina) | Primary |
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