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General NPI Number Information
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NPI Number | 1225697477
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Entity Type | Organization
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Legal Business Name | FORMA MEDICAL SOLUTIONS LLC
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 107 ORANGE ST APT 202
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City | DARLINGTON
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State | SC
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Zip | 29532-3107
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Country | US
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Telephone | 843-536-3375
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Fax | 843-968-9047
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Provider Business Mailing Address
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Address Line | 107 ORANGE ST APT 202
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City | DARLINGTON
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State | SC
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Zip | 29532-3107
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Country | US
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Telephone | 843-536-3375
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Fax | 843-968-9047
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Authorized Official
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Title or Position | CEO
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Name | DAVID IRWIN MORRISEY
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Credential |
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Telephone | 843-536-3375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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