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General NPI Number Information
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NPI Number | 1013382290
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Entity Type | Organization
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Legal Business Name | CJS MEDICAL SERVICES, PC
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 1455 HAGAN AVENUE
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City | HUGER
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State | SC
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Zip | 29450
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Country | US
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Telephone | 843-336-6436
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Fax | 843-336-6836
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Provider Business Mailing Address
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Address Line | 723 BAKER MILL LAKE LN
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City | GASTON
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State | SC
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Zip | 29053-8327
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Country | US
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Telephone | 803-926-0213
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL DAVID SANDERS
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Credential | M.D.
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Telephone | 803-926-0213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 17688
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License Number State | SC
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