Individual
MRS. STACY PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3015 SCUBA DR, CHARLESTON, SC 29414-5696
(843) 901-0824
Mailing address
3015 SCUBA DR, CHARLESTON, SC 29414-5696
(843) 901-0824
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5889
SC
Other
Enumeration date
10/23/2017
Last updated
10/23/2017
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