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General NPI Number Information
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NPI Number | 1225258635
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Entity Type | Organization
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Legal Business Name | MARLBORO CLINIC CORP
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1076 MARLBORO WAY SUITE 1
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-2495
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Country | US
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Telephone | 843-454-2294
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Fax | 843-454-2342
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Provider Business Mailing Address
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Address Line | 7100 COMMERCE WAY SUITE 180
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City | BRENTWOOD
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State | TN
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Zip | 37027-2829
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Country | US
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Telephone | 615-465-7000
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | DEBBIE T BREWER
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Credential |
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Telephone | 615-465-7626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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