Healthcare Provider Details

I. General information

NPI: 1952494304
Provider Name (Legal Business Name): SOUTH STRAND MEDICAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 GLENNS BAY ROAD
SURFSIDE BEACH SC
29575
US

IV. Provider business mailing address

PO BOX 14690
SURFSIDE BEACH SC
29587
US

V. Phone/Fax

Practice location:
  • Phone: 843-650-4006
  • Fax: 843-650-1418
Mailing address:
  • Phone: 843-650-4006
  • Fax: 843-650-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number11949
License Number StateSC

VIII. Authorized Official

Name: BRIAN K ADLER
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 843-650-4006