Organization
PRISMA HEALTH MEDICAL GROUP-MIDLANDS
Active
Other names
PH Oral & Maxillofacial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI LAWRENCE (DIRECTOR PROVIDER ENROLLMENT)
(864) 797-6118
Entity
Organization
Contact information
Practice address
3304 FOREST DR, COLUMBIA, SC 29204-4024
(803) 434-6565
(803) 434-6299
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA8923
—
SC
Enumeration date
04/23/2018
Last updated
02/22/2022
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