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General NPI Number Information
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NPI Number | 1306032214
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Entity Type | Organization
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Legal Business Name | ADJUTANT GENERAL OF SC
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 5471 LEESBURG RD.
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City | EASTOVER
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State | SC
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Zip | 29044-9184
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Country | US
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Telephone | 803-832-4876
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Fax | 803-832-4880
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Provider Business Mailing Address
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Address Line | 1 NATIONAL GUARD RD
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City | COLUMBIA
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State | SC
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Zip | 29201-4752
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Country | US
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Telephone | 803-331-6675
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JACKIE FOGLE
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Credential |
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Telephone | 803-331-6675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | PR38913
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License Number State | SC
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