Individual
TIMOTHY DESOUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
1316 HEARTHSTONE DR, RIDGELAND, SC 29936-7088
(352) 585-5581
Mailing address
PO BOX 1460, HARDEEVILLE, SC 29927-1460
(352) 585-5581
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
04/14/2014
Last updated
01/10/2019
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