Organization
LOW COUNTRY MALE LLC
Active
Organization
LOW COUNTRY MALE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GLENN TWILLEY (CEO)
(843) 936-6451
Entity
Organization
Contact information
Practice address
615 JOHNNIE DODDS BLVD STE 102, MOUNT PLEASANT, SC 29464-3082
(843) 936-6451
(843) 936-6452
Mailing address
615 JOHNNIE DODDS BLVD STE 102, MT PLEASANT, SC 29464-3082
(843) 936-6451
(843) 936-6452
Taxonomy
Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
13315
SC
Other
Enumeration date
10/07/2016
Last updated
11/27/2017
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