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General NPI Number Information
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NPI Number | 1184083982
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Entity Type | Organization
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Legal Business Name | POWDERSVILLE HEALTH INTERNAL MEDICINE
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 3150 HIGHWAY 153
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City | PIEDMONT
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State | SC
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Zip | 29673-9498
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Country | US
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Telephone | 864-568-5018
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Fax | 864-295-0095
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Provider Business Mailing Address
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Address Line | 3150 HIGHWAY 153
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City | PIEDMONT
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State | SC
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Zip | 29673-9498
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Country | US
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Telephone | 864-568-5018
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Fax | 864-295-0095
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. NANCY MCNEELY LOLLIS
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Credential |
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Telephone | 864-568-5018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD38594
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License Number State | SC
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