Healthcare Provider Details

I. General information

NPI: 1932194255
Provider Name (Legal Business Name): SOUTHERN HEALTHSTYLES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 GREGG HWY
AIKEN SC
29801-6341
US

IV. Provider business mailing address

1105 GREGG HWY
AIKEN SC
29801-6341
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-1900
  • Fax:
Mailing address:
  • Phone: 803-649-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HERB MATTOCKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-649-1900