Healthcare Provider Details

I. General information

NPI: 1508034406
Provider Name (Legal Business Name): AMERICAN TELECOMMUNTIONS GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CHESTNUT ST
ORANGEBURG SC
29115-3508
US

IV. Provider business mailing address

PO BOX 507
ORANGEBURG SC
29116-0507
US

V. Phone/Fax

Practice location:
  • Phone: 803-534-7100
  • Fax: 803-534-7184
Mailing address:
  • Phone: 803-534-7100
  • Fax: 803-534-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1640
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1640
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1640
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1640
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK JOHNSON
Title or Position: MANAGER
Credential:
Phone: 803-534-7100