Organization
BALLENTINE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEANNE NICOLA GEURKINK MD (OWNER/PROVIDER)
(803) 732-0920
Entity
Organization
Contact information
Practice address
11134 BROAD RIVER RD, SUITE D, IRMO, SC 29063-9668
(803) 732-0920
(803) 227-2759
Mailing address
11134 BROAD RIVER RD, SUITE D, IRMO, SC 29063-9668
(803) 732-0920
(803) 227-2759
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
19500
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195005
—
SC
Enumeration date
08/04/2008
Last updated
08/04/2008
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