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General NPI Number Information
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NPI Number | 1992911127
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Entity Type | Organization
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Legal Business Name | TERRELL L STONE
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 725 HARRY C RAYSOR DR
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City | ST MATTHEWS
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State | SC
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Zip | 29135-8403
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Country | US
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Telephone | 803-874-3902
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Fax | 803-874-3905
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Provider Business Mailing Address
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Address Line | P O BOX 638 725 HARRY C RAYSOR DRIVE
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City | ST MATTHEWS
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State | SC
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Zip | 29135-0638
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Country | US
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Telephone | 803-874-3902
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Fax | 803-874-3905
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Authorized Official
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Title or Position | OWNER
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Name | TERRELL L STONE
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Credential | MD
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Telephone | 803-874-3902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 13583
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License Number State | SC
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