Organization
AMETHYST HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WACHOVIA CHANTA' BANKS DO (FAMILY MEDICINE PHYSICIAN)
(717) 880-3740
Entity
Organization
Contact information
Practice address
1175 GREY PINE DR, BLYTHEWOOD, SC 29016-7320
(717) 880-3740
Mailing address
1175 GREY PINE DR, BLYTHEWOOD, SC 29016-7320
(717) 880-3740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
04/08/2020
Last updated
04/08/2020
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