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4631 Savannah Highway North SC 29112 | |
(803) 395-2058 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 4631 Savannah Highway, North, South Carolina |
Authorized Official Name and Position | Thomas Dandridge (PRESIDENT) |
Authorized Official Contact | 8033952200 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1245 Orangeburg SC 29116-1245 Ph: (803) 395-4499 | 4631 Savannah Highway North SC 29112 Ph: (803) 395-2058 |
NPI Number | 1548277627 |
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Provider Enumeration Date | 08/02/2006 |
Last Update Date | 11/19/2007 |
Identifier | Type | State | Issuer |
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1548277627 | NPI | - | NPPES |
GP4479 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |