Organization
EDISTO REGIONAL HEALTH SERVICES INC.
Active
Other names
Edisto Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M GOODLETT (C.O.O.)
(803) 395-2462
Entity
Organization
Contact information
Practice address
1619 CAROLINA AVE, ORANGEBURG, SC 29115-4939
(803) 395-4497
(803) 536-0998
Mailing address
PO BOX 1245, ORANGEBURG, SC 29116-1245
(803) 395-4497
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24600
SC
Other
Enumeration date
11/02/2009
Last updated
11/02/2009
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