Organization
SOUTHERN MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NELSON J WAGNER (OWNER)
(843) 453-6784
Entity
Organization
Contact information
Practice address
1822 NIGHTHAWK DR, FLORENCE, SC 29501-8140
(843) 453-6784
Mailing address
1822 NIGHTHAWK DR, FLORENCE, SC 29501-8140
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/12/2008
Last updated
08/18/2008
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