Healthcare Provider Details

I. General information

NPI: 1992911127
Provider Name (Legal Business Name): TERRELL L STONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HARRY C RAYSOR DR
ST MATTHEWS SC
29135-8403
US

IV. Provider business mailing address

P O BOX 638 725 HARRY C RAYSOR DRIVE
ST MATTHEWS SC
29135-0638
US

V. Phone/Fax

Practice location:
  • Phone: 803-874-3902
  • Fax: 803-874-3905
Mailing address:
  • Phone: 803-874-3902
  • Fax: 803-874-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number13583
License Number StateSC

VIII. Authorized Official

Name: TERRELL L STONE
Title or Position: OWNER
Credential: MD
Phone: 803-874-3902