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General NPI Number Information
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NPI Number | 1659121614
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Entity Type | Organization
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Legal Business Name | SOUTHERN CHARM HEALTH & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 211 S PEARL ST
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City | PAGELAND
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State | SC
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Zip | 29728-2261
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Country | US
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Telephone | 803-288-9495
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Fax | 989-214-7326
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Provider Business Mailing Address
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Address Line | 2223 CAMP CREEK RD
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City | LANCASTER
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State | SC
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Zip | 29720-8511
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Country | US
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Telephone | 704-292-3651
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Fax | 989-214-7326
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Authorized Official
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Title or Position | OWNER
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Name | MISS CRYSTAL B CLARK
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Credential | FNP-C
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Telephone | 704-292-3651
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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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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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