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Organization

DIABETES CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BRENT RUSSELL NICOL (BUSINESS MANAGER)
(843) 353-0288
Entity
Organization

Contact information

Practice address
11891 PLAZA DRIVE, MURRELLS INLET, SC 29576
(843) 353-0288
(843) 357-9770
Mailing address
PO BOX 15010, SURFSIDE BEACH, SC 29587-5010
(843) 353-0288
(843) 257-9770

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
30634
SC
207R00000X
Internal Medicine Physician
Primary
14684
SC
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
14684
SC

Other

Enumeration date
08/01/2007
Last updated
05/17/2012
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