Organization
CHESTERFIELD CLINIC CORP
Active
Parent organization
CHESTERFIELD CLINIC CORP
Other names
Carolina Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHESTERFIELD CLINIC CORP
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
309 CLYDE AVE, CHERAW, SC 29520-3029
(843) 921-1211
Mailing address
309 CLYDE AVE, CHERAW, SC 29520-3029
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4534
—
SC
Enumeration date
07/24/2006
Last updated
09/20/2007
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