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General NPI Number Information
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NPI Number | 1336387778
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Entity Type | Organization
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Legal Business Name | POLLOCK PSYCHIATRY LLC
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Dates
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Enumeration Date | 01/22/2009
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 116 BELLE GROVE CIR
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City | COLUMBIA
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State | SC
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Zip | 29229-8906
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Country | US
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Telephone | 803-422-6765
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 291563
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City | COLUMBIA
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State | SC
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Zip | 29229-0027
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Country | US
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Telephone | 803-563-8845
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | RALPH C POLLOCK
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Credential | MD
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Telephone | 803-563-8845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 28154
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License Number State | SC
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