Organization
STAT.MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HARRY NICKEY GORE JR. (COO)
(843) 756-3008
Entity
Organization
Contact information
Practice address
3993 MEETING STREET, LORIS, SC 29569-3053
(843) 756-3008
(843) 756-3128
Mailing address
1209 MILLER RD, TABOR CITY, NC 28463-9266
(910) 840-9559
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
02/11/2015
Last updated
03/18/2015
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