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General NPI Number Information
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NPI Number | 1851008106
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Entity Type | Organization
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Legal Business Name | PEE DEE REGIONAL HOSPITAL FOR GERIATRIC BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 1138 CHERAW ST
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-2466
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Country | US
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Telephone | 919-440-7215
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 LADY STREET 3D FLOOR
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City | COLUMBIA
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State | SC
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Zip | 29201
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Country | US
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Telephone | 919-440-7215
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | NATHANIEL PETERKIN
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Credential |
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Telephone | 919-440-7215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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