# PRISMA HEALTH MEDICAL GROUP-MIDLANDS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PH Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417442864
- **Authorized official:** KRISTI LAWRENCE (DIRECTOR, PROVIDER ENROLLMENT)
- **Authorized official phone:** (864) 522-8611

## Contact information

- **Practice address:** 10 RICHLAND MEDICAL PARK DR STE A, COLUMBIA, SC 29203-6892
- **Practice address phone:** (803) 434-6565
- **Mailing address:** PO BOX 743904, ATLANTA, GA 30374-3904
- **Mailing address phone:** (803) 296-7320
- **Mailing address fax:** (803) 293-7330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | SC | Yes |

## Other

- **Enumeration date:** 06/28/2018
- **Last updated:** 02/22/2022