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General NPI Number Information
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NPI Number | 1861347981
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Entity Type | Organization
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Legal Business Name | DIVINE BLENDING LLC
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 328 HILLCREST DR STE 1
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City | LAURENS
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State | SC
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Zip | 29360-2369
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Country | US
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Telephone | 843-471-0408
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Fax |
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Provider Business Mailing Address
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Address Line | 328 HILLCREST DR STE 1
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City | LAURENS
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State | SC
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Zip | 29360-2369
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Country | US
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Telephone | 843-471-0408
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIFFANY GARY
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Credential | CPT
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Telephone | 803-262-1004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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