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General NPI Number Information
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NPI Number | 1992276091
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL OF SC LLC
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 5880 RIVERS AVE
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-6053
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Country | US
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Telephone | 843-225-2374
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Fax | 843-459-1923
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Provider Business Mailing Address
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Address Line | 354 FOLLY RD STE 5
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City | CHARLESTON
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State | SC
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Zip | 29412-2594
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Country | US
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Telephone | 843-225-2374
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Fax |
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Authorized Official
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Title or Position | MD
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Name | KAREY BREEN
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Credential | MD
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Telephone | 843-225-2374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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