Organization
MIDLANDS MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD HARGRAVE (OWNER)
(803) 419-8700
Entity
Organization
Contact information
Practice address
4531 HARD SCRABBLE RD, COLUMBIA, SC 29229
(803) 419-8700
Mailing address
4531 HARD SCRABBLE RD, COLUMBIA, SC 29229-8561
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/19/2018
Last updated
08/14/2018
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