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2349 Black Pond Lane Wadmalaw Island SC 29487 | |
| (843) 722-4112 | |
| (843) 577-8960 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2349 Black Pond Lane, Wadmalaw Island, South Carolina |
| Authorized Official Name and Position | Aretha Jones (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 8437224122 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
51 Nassau St Charleston SC 29403-5513 Ph: (843) 722-4112 | 2349 Black Pond Lane Wadmalaw Island SC 29487 Ph: (843) 722-4112 |
| NPI Number | 1760933451 |
|---|---|
| Provider Enumeration Date | 10/18/2016 |
| Last Update Date | 10/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760933451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |