Organization
SOUTH CAROLINA NEUROLOGICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDSON H. JOHNSON SR. (ADMINISTRATOR)
(803) 254-6391
Entity
Organization
Contact information
Practice address
1333 TAYLOR ST, SUITE 1-C, COLUMBIA, SC 29201-2923
(803) 254-6391
(803) 799-0682
Mailing address
PO BOX 1488, COLUMBIA, SC 29202-1488
(803) 254-6391
(803) 799-0682
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0421
—
SC
Enumeration date
08/11/2006
Last updated
02/06/2008
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