Organization
EDISTO REGIONAL HEALTH SERVICES INC.
Active
Other names
Family Practice Associates of Holly Hill
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M GOODLETT (C.O.O)
(803) 395-2462
Entity
Organization
Contact information
Practice address
187 BUNCH FORD ROAD, HOLLY HILL, SC 29059
(803) 496-3312
Mailing address
PO BOX 188, HOLLY HILL, SC 29059-0188
(803) 395-4480
(803) 395-4499
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2353
—
SC
Enumeration date
05/08/2006
Last updated
04/15/2010
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