Organization
CAROLINA DEVELOPMENTAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLY DEANNE BRIGMAN M.D. (OWNER AND MEDICAL DIRECTOR)
(803) 957-5856
Entity
Organization
Contact information
Practice address
107 VISTA OAKS DR STE C, LEXINGTON, SC 29072-8230
(803) 957-5856
(803) 957-5856
Mailing address
107 VISTA OAKS DR STE C, LEXINGTON, SC 29072-8230
(803) 957-5856
(803) 957-5856
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
23497
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234972
—
SC
Enumeration date
09/17/2010
Last updated
09/17/2010
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