Organization
DIVINE BLENDING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY GARY CPT (OWNER)
(803) 262-1004
Entity
Organization
Contact information
Practice address
328 HILLCREST DR STE 1, LAURENS, SC 29360-2369
(843) 471-0408
Mailing address
328 HILLCREST DR STE 1, LAURENS, SC 29360-2369
(843) 471-0408
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
—
—
Other
Enumeration date
03/03/2026
Last updated
03/03/2026
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