Individual
JUSTIN MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1951 PISGAH RD STE 122, FLORENCE, SC 29501-6705
(843) 413-2854
Mailing address
1951 PISGAH RD STE 122, FLORENCE, SC 29501-6705
(843) 413-2854
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100452463
LICENSE
SC
Enumeration date
04/02/2020
Last updated
10/07/2021
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