Organization
SC DDSN (MIDLANDS CENTER)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANORAMA MISHRA M.D. (STAFF PHYSICIAN)
(803) 935-6728
Entity
Organization
Contact information
Practice address
8301 FARROW RD, COLUMBIA, SC 29203-3245
(803) 935-7543
(803) 935-6781
Mailing address
8301 FARROW RD, COLUMBIA, SC 29203-3245
(803) 935-7543
(803) 935-6781
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
11487
SC
Other
Enumeration date
02/10/2007
Last updated
08/22/2020
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