Healthcare Provider Details

I. General information

NPI: 1720146848
Provider Name (Legal Business Name): PHYSICIANS HEALTHCARE OF MULLINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 S MAIN ST
MULLINS SC
29574-3120
US

IV. Provider business mailing address

270 S MAIN ST P.O. BOX 330
MULLINS SC
29574-3120
US

V. Phone/Fax

Practice location:
  • Phone: 843-464-8700
  • Fax:
Mailing address:
  • Phone: 843-464-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA F. BRANCH
Title or Position: INSURANCE CLERK
Credential:
Phone: 843-464-8700