Healthcare Provider Details

I. General information

NPI: 1336105527
Provider Name (Legal Business Name): HEALTH PROMOTION SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLD CHEROKEE RD SUITE F, BOX 14
LEXINGTON SC
29072-7959
US

IV. Provider business mailing address

100 OLD CHEROKEE RD SUITE F, BOX 14
LEXINGTON SC
29072-7959
US

V. Phone/Fax

Practice location:
  • Phone: 803-808-2304
  • Fax: 803-808-5642
Mailing address:
  • Phone: 803-808-2950
  • Fax: 803-808-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number927
License Number StateSC

VIII. Authorized Official

Name: MRS. TAMMI O BYRD
Title or Position: CEO
Credential: RDH
Phone: 803-348-2973