Organization
PHILLIP L. LATHAM JR
Active
Other names
Phillip L. Latham Jr
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MILLIE DORMAN (MANAGER)
(803) 775-4469
Entity
Organization
Contact information
Practice address
325 BROAD STREET, SUITE 200, SUMTER, SC 29150
(803) 775-4469
(803) 775-4981
Mailing address
PO BOX 1029, 325 BROAD STREET SUITE 200, SUMTER, SC 29150
(803) 775-4469
(803) 775-4981
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
14449
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144490
—
SC
Enumeration date
09/28/2006
Last updated
12/10/2010
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