Healthcare Provider Details

I. General information

NPI: 1801327176
Provider Name (Legal Business Name): PEE DEE MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CASHUA ST
DARLINGTON SC
29532-3202
US

IV. Provider business mailing address

PO BOX 510
DARLINGTON SC
29540-0510
US

V. Phone/Fax

Practice location:
  • Phone: 843-393-9925
  • Fax:
Mailing address:
  • Phone: 843-393-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS A LOFE
Title or Position: CEO
Credential:
Phone: 843-393-9925