# COMMUNITY MEDICAL CLINIC OF KERSHAW COUNTY

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

## Provider details

- **NPI number:** 1972971117
- **Authorized official:** SUSAN WITKOWSKI CHCQM (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (803) 713-0806

## Contact information

- **Practice address:** 110 E DEKALB ST, SUITE C, CAMDEN, SC 29020-4432
- **Practice address phone:** (803) 713-0806
- **Practice address fax:** (803) 713-0526
- **Mailing address:** 110 E DEKALB ST, SUITE C, CAMDEN, SC 29020-4432
- **Mailing address phone:** (803) 713-0806
- **Mailing address fax:** (803) 713-0526

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 14008 | SC | Yes |

## Other

- **Enumeration date:** 09/04/2015
- **Last updated:** 09/04/2015