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5065 Rackity Hall Rd Wadmalaw Island SC 29487 | |
(843) 722-4112 | |
(843) 577-8960 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 5065 Rackity Hall Rd, Wadmalaw Island, South Carolina |
Authorized Official Name and Position | Aretha R Jones (CEO) |
Authorized Official Contact | 8437224112 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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51 Nassau St Charleston SC 29403-5513 Ph: (843) 722-4112 | 5065 Rackity Hall Rd Wadmalaw Island SC 29487 Ph: (843) 722-4112 |
NPI Number | 1013468792 |
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Provider Enumeration Date | 10/18/2016 |
Last Update Date | 10/28/2022 |
Identifier | Type | State | Issuer |
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1013468792 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |