Individual
ANTONIA MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6720 HOLLYTREE DR, HOLLYWOOD, SC 29449-6919
(843) 860-2615
Mailing address
6720 HOLLYTREE DR, HOLLYWOOD, SC 29449-6919
(843) 860-2615
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
52017
SC
Other
Enumeration date
06/01/2021
Last updated
06/02/2021
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