Organization
WILLIAMSBURG MEDICAL ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PEGGY V MIMS OFFICE MANAGER ASSIS (OFFICE MANAGER ASSISTANT)
(843) 355-7461
Entity
Organization
Contact information
Practice address
500 THURGOOD MARSHALL BLVD, SUITE F, KINGSTREE, SC 29556
(843) 355-7461
(843) 355-3616
Mailing address
500 THURGOOD MARSHALL BLVD, SUITE F, KINGSTREE, SC 29556
(843) 355-7461
(843) 355-3616
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
5526
SC
261QR1300X
Rural Health Clinic/Center
Primary
5526
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055264
—
SC
01
—
428935
RURAL HEALTH MEDICARE
SC
01
—
428935
RURAL HEALTH MEDICARE
TN
05
—
PA7215
—
SC
01
—
RHC103
RURAL HEALTH MEDICAID
SC
Enumeration date
02/05/2007
Last updated
01/10/2008
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