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General NPI Number Information
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NPI Number | 1588618441
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Entity Type | Organization
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Legal Business Name | ST JAMES HEALTH AND WELLNESS INC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 1189 TIBWIN RD
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City | MC CLELLANVILLE
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State | SC
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Zip | 29458-9405
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Country | US
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Telephone | 843-887-3274
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Fax | 843-887-3929
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Provider Business Mailing Address
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Address Line | PO BOX 608 1189 TIBWIN ROAD
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City | MC CLELLANVILLE
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State | SC
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Zip | 29458-0608
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Country | US
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Telephone | 843-887-3274
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Fax | 843-887-3929
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Authorized Official
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Title or Position | CEO
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Name | MRS. SANRDA GILLIARD
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Credential |
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Telephone | 843-887-3274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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