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3310 Magnolia St Orangeburg SC 29115-1466 | |
| (803) 531-6900 | |
| (803) 531-8988 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 3310 Magnolia St, Orangeburg, South Carolina |
| Authorized Official Name and Position | Leon A. Brunson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8035316900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3310 Magnolia St Orangeburg SC 29115-1466 Ph: (803) 531-6900 | 3310 Magnolia St Orangeburg SC 29115-1466 Ph: (803) 531-6900 |
| NPI Number | 1417388471 |
|---|---|
| Provider Enumeration Date | 12/02/2013 |
| Last Update Date | 12/02/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417388471 | NPI | - | NPPES |
| 005593 | Other | SC | STATE LIC. NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 005593 (South Carolina) | Primary |
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