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115 N Sumter St Suite 400 Sumter SC 29150-4972 | |
| (803) 774-7425 | |
| (803) 774-9426 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 115 N Sumter St, Sumter, South Carolina |
| Authorized Official Name and Position | Darrell Coven (DIRECTOR, BUS FINANCE) |
| Authorized Official Contact | 8032967301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 402145 Atlanta GA 30384-2145 Ph: (803) 296-7303 | 115 N Sumter St Suite 400 Sumter SC 29150-4972 Ph: (803) 774-7425 |
| NPI Number | 1710342787 |
|---|---|
| Provider Enumeration Date | 12/17/2015 |
| Last Update Date | 06/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710342787 | NPI | - | NPPES |
| GP7159 | Medicaid | SC |
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