Healthcare Provider Details

I. General information

NPI: 1326744632
Provider Name (Legal Business Name): 14TH CIRCUIT SOLICITOR'S OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 TRADERS CROSS
OKATIE SC
29909-4610
US

IV. Provider business mailing address

PO BOX 1880
BLUFFTON SC
29910-1880
US

V. Phone/Fax

Practice location:
  • Phone: 843-212-2441
  • Fax:
Mailing address:
  • Phone: 843-212-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER TALLEY
Title or Position: SAFE/SANE COORDINATOR
Credential: RN
Phone: 843-212-2441