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Organization
PRISMA HEALTH MEDICAL GROUP-MIDLANDS
Active
Organization
PRISMA HEALTH MEDICAL GROUP-MIDLANDS
Active
Other names
PH Medical Group Midlands
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI LAWRENCE (DIRECTOR PROVIDER ENROLLMENT)
(864) 797-6118
Entity
Organization
Contact information
Practice address
115 N SUMTER ST STE 115, SUMTER, SC 29150-4968
(803) 774-7546
(803) 774-9735
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP8508
—
SC
Enumeration date
05/04/2018
Last updated
12/18/2020
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