Healthcare Provider Details

I. General information

NPI: 1629165105
Provider Name (Legal Business Name): WELLFORD FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ASTOR ST
WELLFORD SC
29385
US

IV. Provider business mailing address

102 ASTOR ST
WELLFORD SC
29385
US

V. Phone/Fax

Practice location:
  • Phone: 864-439-5338
  • Fax: 864-439-4769
Mailing address:
  • Phone: 864-439-5338
  • Fax: 864-439-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10286
License Number StateSC

VIII. Authorized Official

Name: DR. ROBERT BARNWELL HARRIS JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 864-439-5338