Healthcare Provider Details

I. General information

NPI: 1588412175
Provider Name (Legal Business Name): UZA32SC02
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 SECOND BAXTER XING STE 108A
FORT MILL SC
29708-6436
US

IV. Provider business mailing address

4540 SOUTHSIDE BLVD STE 202
JACKSONVILLE FL
32216-5488
US

V. Phone/Fax

Practice location:
  • Phone: 803-802-2225
  • Fax:
Mailing address:
  • Phone: 904-503-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL CURTIS
Title or Position: MANAGER
Credential: DC
Phone: 803-800-4161