| Table Rock Integrated Health And Wellness Practice, Llc. | |
|
5 Center St Travelers Rest SC 29690-1826 | |
| (864) 908-6372 | |
| (864) 898-3703 |
| Full Name | Table Rock Integrated Health And Wellness Practice, Llc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5 Center St, Travelers Rest, South Carolina |
| Authorized Official Name and Position | Gergana Damianova Dimitrova (PARTNER) |
| Authorized Official Contact | 8649086372 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Table Rock Integrated Health And Wellness Practice, Llc. 5 Center St Travelers Rest SC 29690-1826 Ph: (864) 908-6372 | Table Rock Integrated Health And Wellness Practice, Llc. 5 Center St Travelers Rest SC 29690-1826 Ph: (864) 908-6372 |
| NPI Number | 1104145184 |
|---|---|
| Provider Enumeration Date | 05/31/2010 |
| Last Update Date | 03/16/2020 |
| Certification Date | 03/16/2020 |
| Medicare PECOS PAC ID | 0648462333 |
|---|---|
| Medicare Enrollment ID | O20101013000875 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104145184 | NPI | - | NPPES |
| Provider Name | Gergana D Dimitrova |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326129388 PECOS PAC ID: 3476628181 Enrollment ID: I20080814000509 |
| Provider Name | Pamela A Mcafee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770791311 PECOS PAC ID: 3173820859 Enrollment ID: I20160323001447 |
| Provider Name | John Edward Epps |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346486982 PECOS PAC ID: 3678993839 Enrollment ID: I20201009000826 |
| Provider Name | Siana Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710670864 PECOS PAC ID: 1052765278 Enrollment ID: I20230921002982 |
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