Organization
WOODLANDWAY FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH H. BECKER M.D. (PRESIDENT)
(864) 972-5720
Entity
Organization
Contact information
Practice address
111 WEST PINE GROVE RD, FAIRPLAY, SC 29643
(864) 972-5720
(864) 972-5724
Mailing address
PO BOX 98, FAIR PLAY, SC 29643-0098
(864) 972-5720
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23572
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235720
—
SC
Enumeration date
07/26/2007
Last updated
07/26/2007
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