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General NPI Number Information
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NPI Number | 1407182371
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Entity Type | Organization
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Legal Business Name | MCLEOD FAMILY MEDICINE PA
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 110 DOCTORS DR STE B2
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City | CHERAW
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State | SC
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Zip | 29520-7112
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Country | US
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Telephone | 843-537-9932
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Fax | 843-537-9936
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Provider Business Mailing Address
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Address Line | 110 DOCTORS DR STE B2
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City | CHERAW
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State | SC
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Zip | 29520-7112
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Country | US
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Telephone | 843-537-9932
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Fax | 843-537-9936
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JANET G TEAL
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Credential |
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Telephone | 843-537-9932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15756
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License Number State | SC
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