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Organization
PINE TREE FAMILY PRACTICE, P. A.
Active
Organization
PINE TREE FAMILY PRACTICE, P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE SAMUEL JOHNSTON M.D. (PHYSICIAN)
(864) 366-9611
Entity
Organization
Contact information
Practice address
901 W GREENWOOD ST, BUILDING 2, ABBEVILLE, SC 29620-5678
(864) 366-9611
(864) 366-8521
Mailing address
PO BOX 1126, ABBEVILLE, SC 29620-1126
(864) 366-9611
(864) 366-8521
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8390
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080172913
RAILROAD MEDICARE
SC
05
—
PC0557
—
SC
Enumeration date
06/28/2007
Last updated
02/21/2011
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