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General NPI Number Information
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NPI Number | 1255608113
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Entity Type | Organization
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Legal Business Name | PHYSICIANS HEALTHCARE OF DILLON
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 1639 HIGHWAY 301 N
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City | DILLON
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State | SC
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Zip | 29536-1945
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Country | US
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Telephone | 843-774-5182
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Fax |
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Provider Business Mailing Address
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Address Line | 1639 HIGHWAY 301 N
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City | DILLON
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State | SC
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Zip | 29536-1945
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Country | US
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Telephone | 843-774-5182
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN KEMPER STANTON IX
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Credential | DC
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Telephone | 843-774-5182
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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 | 17253
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License Number State | SC
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