Healthcare Provider Details

I. General information

NPI: 1932113230
Provider Name (Legal Business Name): FAMILY DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 HOLLY ST
HOLLY HILL SC
29059-2762
US

IV. Provider business mailing address

922 HOLLY ST
HOLLY HILL SC
29059-2762
US

V. Phone/Fax

Practice location:
  • Phone: 803-496-7174
  • Fax: 803-496-7928
Mailing address:
  • Phone: 803-496-7174
  • Fax: 803-496-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER L WAY
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 803-496-7174