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General NPI Number Information
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NPI Number | 1447714993
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Entity Type | Organization
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Legal Business Name | BEACH MEDICAL WEIGHT LOSS NORTH AUGUSTA SC LLC
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 220 EDGEFIELD RD
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-1941
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Country | US
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Telephone | 803-426-8882
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Fax | 803-426-8910
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Provider Business Mailing Address
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Address Line | 220 EDGEFIELD RD
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-1941
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Country | US
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Telephone | 803-426-8882
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Fax | 803-426-8910
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Authorized Official
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Title or Position | OWNER
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Name | DONALD ROGERS
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Credential |
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Telephone | 803-426-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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