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Organization
FAMILY LIFE MEDICINE
Active
Organization
FAMILY LIFE MEDICINE
Active
Parent organization
LORIS COMMUNITY HOSPITAL DISTRICT
Organization subpart
Yes
Provider details
NPI number
Legal business name
LORIS COMMUNITY HOSPITAL DISTRICT
Authorized official
MRS. CAROLYN WARD (LORIS PHYSICIANS CREDENTIALING)
(919) 880-6406
Entity
Organization
Contact information
Practice address
7209 HWY 90, SUITE C, LONGS, SC 29568
(843) 390-1800
(843) 390-1817
Mailing address
7209 HWY 90, SUITE C, LONGS, SC 29568
(843) 390-1800
(843) 390-1817
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
TL32240
SC
Other
Enumeration date
12/08/2009
Last updated
12/08/2009
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