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General NPI Number Information
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NPI Number | 1396386942
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Entity Type | Organization
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Legal Business Name | THE BHANG GROUP
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 1320 MAIN ST STE 300
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City | COLUMBIA
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State | SC
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Zip | 29201-3266
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Country | US
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Telephone | 803-724-1250
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Fax | 803-724-1200
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Provider Business Mailing Address
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Address Line | 1320 MAIN ST STE 300
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City | COLUMBIA
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State | SC
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Zip | 29201-3266
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Country | US
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Telephone | 803-724-1250
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Fax | 803-724-1200
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Authorized Official
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Title or Position | CEO
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Name | PRUNETTA BRUNSON
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Credential | NP
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Telephone | 803-724-1250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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