| Tamara Willard | |
|
4221 Mayfair St Myrtle Beach SC 29577-5757 | |
| (843) 360-9491 | |
| Not Available |
| Full Name | Tamara Willard |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4221 Mayfair St, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Tamara Willard (OWNER) |
| Authorized Official Contact | 8433609491 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tamara Willard 4221 Mayfair St Myrtle Beach SC 29577-5757 Ph: () - | Tamara Willard 4221 Mayfair St Myrtle Beach SC 29577-5757 Ph: (843) 360-9491 |
| NPI Number | 1215462742 |
|---|---|
| Provider Enumeration Date | 04/21/2017 |
| Last Update Date | 04/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215462742 | NPI | - | NPPES |
| PC1117 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 4859 (South Carolina) | Primary |
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