Organization
NEXTPHASEMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE SUZANNE QUAYE MD (CEO)
(843) 861-2726
Entity
Organization
Contact information
Practice address
107 W COLLEGE AVE, HARTSVILLE, SC 29550-4113
(843) 861-2726
Mailing address
PO BOX 1763, HARTSVILLE, SC 29551-1763
(843) 861-2726
(843) 536-4194
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
22891
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22891
SC STATE LICENSE
SC
05
—
228916
—
SC
01
—
SC 2958B578
PTAN
SC
Enumeration date
04/06/2016
Last updated
04/06/2016
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