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General NPI Number Information
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NPI Number | 1891317228
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Entity Type | Organization
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Legal Business Name | MAX PRIMARY CARE LLC
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 605 W PALMETTO ST
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City | FLORENCE
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State | SC
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Zip | 29501-4301
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Country | US
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Telephone | 843-942-9960
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Fax | 843-799-5088
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Provider Business Mailing Address
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Address Line | 1209 CENTRAL RD
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City | OLANTA
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State | SC
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Zip | 29114-9773
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Country | US
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Telephone | 843-616-3410
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Fax | 802-400-2609
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Authorized Official
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Title or Position | OWNER
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Name | GEORGE MAXIE HARRISON III
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Credential | APRN FNP-C
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Telephone | 843-942-9960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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Taxonomy #3
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number |
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Taxonomy #4
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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Taxonomy #6
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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Taxonomy #7
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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Taxonomy #8
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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Taxonomy #9
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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Taxonomy #10
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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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