Organization
COLLETON EMERGENCY GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SYLVAN M WALLER MD (PRESIDENT)
(800) 893-9698
Entity
Organization
Contact information
Practice address
501 ROBERTSON BLVD, WALTERBORO, SC 29488-2787
(843) 549-2000
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4948
—
SC
Enumeration date
07/30/2008
Last updated
09/17/2010
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