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General NPI Number Information
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NPI Number | 1205256732
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Entity Type | Organization
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Legal Business Name | ALL SEASONS MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 04/26/2014
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Provider Practice Location Address
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Address Line | 7142 WOODROW ST
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City | IRMO
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State | SC
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Zip | 29063-2832
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Country | US
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Telephone | 803-929-7784
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Fax | 803-929-7834
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Provider Business Mailing Address
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Address Line | PO BOX 3635
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City | IRMO
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State | SC
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Zip | 29063-4018
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Country | US
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Telephone | 803-929-7784
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Fax | 803-929-7834
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY L. PHILLIPS
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Credential |
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Telephone | 803-309-1275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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