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General NPI Number Information
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NPI Number | 1750474128
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Entity Type | Organization
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Legal Business Name | AMSOL PHYSICIANS OF WALTERBORO SC LLC
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 501 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488-2787
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Country | US
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Telephone | 843-549-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 501 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488-2787
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Country | US
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Telephone | 843-549-2000
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ALAN DALE HILLIARD
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Credential | CPA
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Telephone | 843-549-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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