Healthcare Provider Details

I. General information

NPI: 1205256732
Provider Name (Legal Business Name): ALL SEASONS MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7142 WOODROW ST
IRMO SC
29063-2832
US

IV. Provider business mailing address

PO BOX 3635
IRMO SC
29063-4018
US

V. Phone/Fax

Practice location:
  • Phone: 803-929-7784
  • Fax: 803-929-7834
Mailing address:
  • Phone: 803-929-7784
  • Fax: 803-929-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY L. PHILLIPS
Title or Position: PRESIDENT
Credential:
Phone: 803-309-1275