Healthcare Provider Details

I. General information

NPI: 1962250258
Provider Name (Legal Business Name): ST. JAMES HEALTH AND WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 POWELL RD
GEORGETOWN SC
29440-8136
US

IV. Provider business mailing address

PO BOX 608
MC CLELLANVILLE SC
29458-0608
US

V. Phone/Fax

Practice location:
  • Phone: 843-990-7993
  • Fax: 843-887-3817
Mailing address:
  • Phone: 843-990-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SANDRA D GILLIARD
Title or Position: CEO
Credential:
Phone: 843-990-7993