| N/a | |
|
2719 Middleburg Dr Suite 201 Columbia SC 29204-2414 | |
| (803) 256-6828 | |
| (803) 256-6827 |
| Full Name | N/a |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2719 Middleburg Dr, Columbia, South Carolina |
| Authorized Official Name and Position | Yohannes Negash (PRESIDENT) |
| Authorized Official Contact | 8032566828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 2719 Middleburg Dr Suite 201 Columbia SC 29204-2414 Ph: (803) 256-6828 | N/a 2719 Middleburg Dr Suite 201 Columbia SC 29204-2414 Ph: (803) 256-6828 |
| NPI Number | 1265440705 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265440705 | NPI | - | NPPES |
| GP3800 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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