| Bull St. District Family Practice Llc | |
|
1417 Gregg St Columbia SC 29201-3527 | |
| (803) 915-0469 | |
| Not Available |
| Full Name | Bull St. District Family Practice Llc |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 1417 Gregg St, Columbia, South Carolina |
| Authorized Official Name and Position | Cornell Maurice Clark (MANAGING DIRECTOR) |
| Authorized Official Contact | 7029044077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bull St. District Family Practice Llc Po Box 99 Columbia SC 29202-0099 Ph: (803) 915-0469 | Bull St. District Family Practice Llc 1417 Gregg St Columbia SC 29201-3527 Ph: (803) 915-0469 |
| NPI Number | 1265232326 |
|---|---|
| Provider Enumeration Date | 03/18/2025 |
| Last Update Date | 03/18/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265232326 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
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