Organization
SOUTHEASTERN MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NOWAMAGBE A OMOIGUI MD (PHYSICIAN)
(803) 957-0770
Entity
Organization
Contact information
Practice address
609 SOUTH LAKE DR, STE 1, LEXINGTON, SC 29072-4119
(803) 957-0770
(803) 957-0909
Mailing address
609 SOUTH LAKE DR, STE 1, LEXINGTON, SC 29072-4119
(803) 957-0770
(803) 957-0909
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17764
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
DR. OMOIGUI SSN
SC
01
—
1386645596
DR. OMOIGUI IND NPI #
SC
01
—
17764
SC MEDICAL LICENSE #
SC
Enumeration date
07/29/2006
Last updated
05/21/2020
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