=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649650375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTH CENTERS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2015
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5616 CAROLINA HWY
-----------------------------------------------------
City | DENMARK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29042-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-793-4282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3310 MAGNOLIA ST
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29115-1466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-531-6900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. STAN WARDLAW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-531-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------