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General NPI Number Information
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NPI Number | 1356008288
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Entity Type | Organization
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Legal Business Name | TT&S DECON, LLC
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Dates
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Enumeration Date | 11/28/2021
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Last Update Date | 11/28/2021
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Provider Practice Location Address
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Address Line | 917 CASSIDY RD
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City | GASTON
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State | SC
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Zip | 29053-9733
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Country | US
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Telephone | 803-206-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 917 CASSIDY RD
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City | GASTON
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State | SC
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Zip | 29053-9733
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Country | US
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Telephone | 803-206-3577
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY WYNETT SUTTON
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Credential |
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Telephone | 803-206-3577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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