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General NPI Number Information
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NPI Number | 1144038274
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Entity Type | Organization
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Legal Business Name | NU SOUTH PROVIDERS
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 117 NORTH HIGHWAY 52 UNIT 56
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City | MONCKS CORNER
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State | SC
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Zip | 29461-0056
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Country | US
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Telephone | 843-900-7098
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 56
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City | MONCKS CORNER
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State | SC
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Zip | 29461-0056
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Country | US
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Telephone | 843-900-7098
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALISTS
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Name | KIMBERLY DAVIS
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Credential |
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Telephone | 912-373-4385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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