Individual
DAMITCHELL DETAVIOUS MONTEZ MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NCPT
Contact information
Practice address
136-4 FORUM DR #234, COLUMBIA, SC 29229
(839) 234-0175
Mailing address
136-4 FORUM DR #234, COLUMBIA, SC 29229
(839) 234-0175
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
SC
Other
Enumeration date
03/27/2024
Last updated
03/31/2024
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