Individual
STAVROS CHRYSOSTOMIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1910 BLANDING ST, COLUMBIA, SC 29201-3520
(803) 256-4107
Mailing address
1910 BLANDING STREET, COLUMBIA, SC 29201
(803) 256-4107
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2399
SC
Other
Enumeration date
09/03/2015
Last updated
07/21/2022
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