| Edisto Family Practice | |
|
1619 Carolina Ave Orangeburg SC 29115-4939 | |
| (803) 395-4497 | |
| (803) 536-0998 |
| Full Name | Edisto Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 1619 Carolina Ave, Orangeburg, South Carolina |
| Authorized Official Name and Position | Lisa M Goodlett (C.O.O.) |
| Authorized Official Contact | 8033952462 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edisto Family Practice Po Box 1245 Orangeburg SC 29116-1245 Ph: (803) 395-4497 | Edisto Family Practice 1619 Carolina Ave Orangeburg SC 29115-4939 Ph: (803) 395-4497 |
| NPI Number | 1225364870 |
|---|---|
| Provider Enumeration Date | 11/02/2009 |
| Last Update Date | 11/02/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225364870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 24600 (South Carolina) | Primary |
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