Organization
SOUTH CHARLESTON PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI JO COLEMAN (OFFICE MANAGER)
(304) 744-4532
Entity
Organization
Contact information
Practice address
312 6TH AVE, SUITE 3, SOUTH CHARLESTON, WV 25303-1242
(304) 744-4532
(304) 744-3219
Mailing address
312 6TH AVE, SUITE 3, SOUTH CHARLESTON, WV 25303-1242
(304) 744-4532
(304) 744-3219
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10611
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009405002
—
WV
Enumeration date
10/25/2006
Last updated
08/22/2020
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