Organization
MAIN STREET MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL MANDUS JOHNSON III M.D. (CEO DOCTOR)
(843) 681-3777
Entity
Organization
Contact information
Practice address
93 MAIN ST, HILTON HEAD, SC 29926-1648
(843) 681-3777
(843) 681-9996
Mailing address
93 MAIN ST, HILTON HEAD, SC 29926-1648
(843) 681-3777
(843) 681-9996
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
18011
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020038172
RAIL ROAD MEDICARE
SC
01
—
42D0940826
CLIA NUMBER
SC
Enumeration date
10/03/2006
Last updated
01/15/2020
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