Organization
GENERAL MEDICINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARY GORE BA (OFFICE MANAGER)
(843) 479-3837
Entity
Organization
Contact information
Practice address
304 MARKET STREET, BENNETTSVILLE, SC 29512
(843) 479-3837
Mailing address
304 MARKET STREET, BENNETTSVILLE, SC 29512
(843) 479-3837
(843) 479-3931
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5707
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA0098
—
SC
Enumeration date
04/27/2007
Last updated
10/26/2007
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