Healthcare Provider Details

I. General information

NPI: 1801633524
Provider Name (Legal Business Name): NSO GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEDICAL CIR STE A
WEST COLUMBIA SC
29169-3650
US

IV. Provider business mailing address

PO BOX 7227
WEST COLUMBIA SC
29171-7227
US

V. Phone/Fax

Practice location:
  • Phone: 803-244-9212
  • Fax: 803-708-0865
Mailing address:
  • Phone: 803-244-9212
  • Fax: 803-708-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUG WILLIAMS
Title or Position: BILLING MANAGER
Credential:
Phone: 803-244-9212