Organization
MCLEOD HEALTH CLARENDON
Active
Other names
McLeod Family Medicine-Johnsonville
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL FULTON ERVIN III (SR VICE PRESIDENT AND CFO)
(843) 777-2910
Entity
Organization
Contact information
Practice address
355 S GEORGETOWN HWY, JOHNSONVILLE, SC 29555-8083
(843) 380-2000
Mailing address
PO BOX 100567, FLORENCE, SC 29502-0567
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42-8989
PTAN
SC
05
—
GP2568
—
SC
05
—
RHC176
—
SC
Enumeration date
08/09/2019
Last updated
08/14/2019
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