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General NPI Number Information
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NPI Number | 1598760951
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Entity Type | Organization
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Legal Business Name | THREE RIVERS OB/GYN ASSOCIATES, PA
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 1301 TAYLOR ST STE 7B
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City | COLUMBIA
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State | SC
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Zip | 29201-2972
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Country | US
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Telephone | 803-254-9461
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Fax | 803-254-9318
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Provider Business Mailing Address
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Address Line | 1301 TAYLOR ST STE 7B
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City | COLUMBIA
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State | SC
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Zip | 29201-2972
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Country | US
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Telephone | 803-254-9461
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Fax | 803-254-9318
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES H. JOHNSON JR.
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Credential | M.D.
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Telephone | 803-254-9461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 8251
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License Number State | SC
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