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General NPI Number Information
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NPI Number | 1962731117
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Entity Type | Organization
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Legal Business Name | SOUTH CAROLINA HIV/AIDS COUNCIL
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 1115 CALHOUN ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2417
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Country | US
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Telephone | 803-254-6644
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Fax | 803-254-2209
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Provider Business Mailing Address
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Address Line | 1115 CALHOUN ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2417
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Country | US
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Telephone | 803-254-6644
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Fax | 803-254-2209
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. BAMBI W GADDIST
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Credential | DRPH
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Telephone | 803-254-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 42D1011461
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License Number State | SC
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