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1727 Village Park Dr Orangeburg SC 29118-2475 | |
| (803) 531-2722 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1727 Village Park Dr, Orangeburg, 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 |
|---|---|
Po Box 1442 Orangeburg SC 29116-1442 Ph: (803) 395-4499 | 1727 Village Park Dr Orangeburg SC 29118-2475 Ph: (803) 531-2722 |
| NPI Number | 1639117732 |
|---|---|
| Provider Enumeration Date | 06/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639117732 | NPI | - | NPPES |
| GP4305 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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