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General NPI Number Information
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NPI Number | 1285248781
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Entity Type | Organization
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Legal Business Name | PPCP SPECIALTY PHYSICIANS , LLC
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 3700 FOREST DR STE 200
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City | COLUMBIA
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State | SC
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Zip | 29204-4010
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Country | US
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Telephone | 803-799-1922
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 530062
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City | ATLANTA
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State | GA
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Zip | 30353-0062
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Country | US
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Telephone | 843-695-6071
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Fax | 843-569-5879
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Authorized Official
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Title or Position | CEO
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Name | TERRY CUNNINGHAM
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Credential |
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Telephone | 843-695-6071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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