Organization
LAKE MARION PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAUNDRA WALLACE (ADMINISTRATOR)
(803) 435-2529
Entity
Organization
Contact information
Practice address
15 E HOSPITAL ST, MANNING, SC 29102-3152
(803) 435-2529
(803) 435-4196
Mailing address
15 E HOSPITAL ST, MANNING, SC 29102-3152
(803) 435-2529
(803) 435-4196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
13275
SC
207RC0000X
Cardiovascular Disease Physician
Primary
20345
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2178
—
SC
Enumeration date
04/27/2006
Last updated
09/11/2025
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