Individual
DR. ALBERT D MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
148 SAULS ST, LAKE CITY, SC 29560-2631
(843) 374-3621
(843) 374-3624
Mailing address
PO BOX 603898, CHARLOTTE, NC 28260-3898
(843) 374-3621
(843) 374-3624
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9352
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093525
—
SC
01
—
P011055604
RR PTAN
SC
Enumeration date
09/16/2006
Last updated
11/19/2020
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