Organization
CHESTERFIELD CLINIC CORP
Active
Parent organization
CHESTERFIELD CLINIC CORP
Other names
Carolina Surgical Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHESTERFIELD CLINIC CORP
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
715 S DOCTORS DR, SUITE C, CHERAW, SC 29520-7113
(843) 320-9086
(843) 320-9087
Mailing address
715 S DOCTORS DR, SUITE C, CHERAW, SC 29520-7113
(843) 320-9086
(843) 320-9087
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1883
—
SC
05
—
GP3624
—
SC
Enumeration date
12/06/2006
Last updated
09/20/2007
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