| Traditions Health Of Augusta | |
|
215 Ronnie Ct Ste D Myrtle Beach SC 29579-4204 | |
| (843) 504-3421 | |
| (843) 504-3422 |
| Full Name | Traditions Health Of Augusta |
|---|---|
| Speciality | Clinic/Center |
| Location | 215 Ronnie Ct Ste D, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | David R Klementz (PRESIDENT & CEO) |
| Authorized Official Contact | 9797046547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Traditions Health Of Augusta 150 4th Ave N Ste 2300 Nashville TN 37219-2466 Ph: (979) 704-2466 | Traditions Health Of Augusta 215 Ronnie Ct Ste D Myrtle Beach SC 29579-4204 Ph: (843) 504-3421 |
| NPI Number | 1013653401 |
|---|---|
| Provider Enumeration Date | 05/09/2022 |
| Last Update Date | 09/11/2023 |
| Medicare PECOS PAC ID | 2264676113 |
|---|---|
| Medicare Enrollment ID | O20220629002206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013653401 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Steven Barnett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134175557 PECOS PAC ID: 2860395621 Enrollment ID: I20040129000307 |
| Provider Name | Donnielle Lynn Green |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073620530 PECOS PAC ID: 6800810375 Enrollment ID: I20060124000086 |
| Provider Name | Jasmine Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902280001 PECOS PAC ID: 7810205853 Enrollment ID: I20150924002341 |
| Provider Name | Clarissa Latoya Carelock-lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184075475 PECOS PAC ID: 7911293154 Enrollment ID: I20160914000881 |
| Provider Name | Wanda Fay Lowery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366683823 PECOS PAC ID: 8527116276 Enrollment ID: I20161025002572 |
| Provider Name | Tomeka D Payton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992085401 PECOS PAC ID: 5698036879 Enrollment ID: I20230112000629 |
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