Organization
PIEDMONT FAMILY PRACTICE AT TEGA CAY, LLC
Active
Other names
Piedmont Family Practice at Tega Cay
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WESLEY O. JAMES (REGIONAL CFO, TENET)
(404) 265-5009
Entity
Organization
Contact information
Practice address
773 STOCKBRIDGE DRIVE, FORT MILL, SC 29708
(803) 802-2424
(803) 802-3767
Mailing address
773 STOCKBRIDGE DRIVE, FORT MILL, SC 29708
(803) 802-2424
(803) 802-3767
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO0992
RAILROAD MEDICARE PTAN NUMBER
SC
05
—
GP4723
—
SC
Enumeration date
08/02/2006
Last updated
06/23/2016
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