Organization
PROVIDENCE PHYSICIAN PRACTICES, LLC
Active
Other names
Laurel Imaging Center
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE DILLON (ASSISTANT SECRETARY)
(502) 596-7220
Entity
Organization
Contact information
Practice address
2750 LAUREL ST, SUITE 104, COLUMBIA, SC 29204-2038
(803) 799-9035
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
(615) 920-8913
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Enumeration date
02/16/2016
Last updated
04/25/2022
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