Individual
GRACE SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6450 RIVERS AVE, NORTH CHARLESTON, SC 29406-4882
(843) 818-5100
Mailing address
58 RED BLUFF ST, SUMMERVILLE, SC 29483-8222
(330) 780-0102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.142992
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2019
Last updated
11/18/2024
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