# DIABETES CENTER LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114117488
- **Authorized official:** MR. BRENT RUSSELL NICOL (BUSINESS MANAGER)
- **Authorized official phone:** (843) 353-0288

## Contact information

- **Practice address:** 11891 PLAZA DRIVE, MURRELLS INLET, SC 29576
- **Practice address phone:** (843) 353-0288
- **Practice address fax:** (843) 357-9770
- **Mailing address:** PO BOX 15010, SURFSIDE BEACH, SC 29587-5010
- **Mailing address phone:** (843) 353-0288
- **Mailing address fax:** (843) 257-9770

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 30634 | SC | — |
| 207R00000X | Internal Medicine Physician | 14684 | SC | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | 14684 | SC | — |

## Other

- **Enumeration date:** 08/01/2007
- **Last updated:** 05/17/2012