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General NPI Number Information
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NPI Number | 1568536050
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Entity Type | Organization
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Legal Business Name | SMALL WONDERS IMAGING, LLC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 308 S PINE ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6048
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Country | US
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Telephone | 843-817-6345
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Fax |
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Provider Business Mailing Address
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Address Line | 308 S PINE ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6048
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Country | US
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Telephone | 843-817-6345
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | HOLLY RACQUEL POE
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Credential | ARDMS, RVT
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Telephone | 843-817-6345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 79275
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License Number State | SC
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