Healthcare Provider Details

I. General information

NPI: 1821056110
Provider Name (Legal Business Name): PEE DEE ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2928 E HIGHWAY 76
MULLINS SC
29574-6039
US

IV. Provider business mailing address

PO BOX 2429
MURRELLS INLET SC
29576-2429
US

V. Phone/Fax

Practice location:
  • Phone: 843-431-2000
  • Fax:
Mailing address:
  • Phone: 843-651-2624
  • Fax: 843-357-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD C JOHNSON
Title or Position: PRESIDENT
Credential: CRNA
Phone: 843-431-2000