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General NPI Number Information
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NPI Number | 1083809958
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Entity Type | Organization
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Legal Business Name | RICE PLANTER PEDIATRICS LLC
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 416 ROBERTSON BLVD STE D
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City | WALTERBORO
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State | SC
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Zip | 29488-2952
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Country | US
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Telephone | 843-782-5437
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Fax | 843-782-4269
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Provider Business Mailing Address
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Address Line | 317 WINTERGREEN RD
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City | WALTERBORO
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State | SC
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Zip | 29488-9512
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Country | US
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Telephone | 843-782-5437
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Fax | 843-782-4269
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHERYL ANTIONETTE GRANT
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Credential | MD
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Telephone | 843-509-5848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25971
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License Number State | SC
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