Healthcare Provider Details

I. General information

NPI: 1356008288
Provider Name (Legal Business Name): TT&S DECON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 11/28/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 CASSIDY RD
GASTON SC
29053-9733
US

IV. Provider business mailing address

917 CASSIDY RD
GASTON SC
29053-9733
US

V. Phone/Fax

Practice location:
  • Phone: 803-206-3577
  • Fax:
Mailing address:
  • Phone: 803-206-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: TAMMY WYNETT SUTTON
Title or Position: OWNER
Credential:
Phone: 803-206-3577