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Organization
CONWAY HOSPITAL COMMUNITY SERVICES
Active
Organization
CONWAY HOSPITAL COMMUNITY SERVICES
Active
Other names
AYNOR FAMILY PRACTICE, Aynor Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN ARTIOLI (CREDENTIALING SPECIALIST)
(843) 234-6946
Entity
Organization
Contact information
Practice address
1213 ELM ST, AYNOR, SC 29511-3320
(843) 358-5806
(843) 358-9205
Mailing address
300 SINGLETON RIDGE RD, ATTENTION PNS CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
828
SC
207Q00000X
Family Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4505
—
SC
Enumeration date
12/06/2006
Last updated
08/23/2024
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