# MAIN STREET MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922192194
- **Authorized official:** DR. JOEL MANDUS JOHNSON III M.D. (CEO DOCTOR)
- **Authorized official phone:** (843) 681-3777

## Contact information

- **Practice address:** 93 MAIN ST, HILTON HEAD, SC 29926-1648
- **Practice address phone:** (843) 681-3777
- **Practice address fax:** (843) 681-9996
- **Mailing address:** 93 MAIN ST, HILTON HEAD, SC 29926-1648
- **Mailing address phone:** (843) 681-3777
- **Mailing address fax:** (843) 681-9996

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 18011 | SC | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 01/15/2020