| PH Medical Group Midlands | |
|
115 N Sumter St Ste 115 Sumter SC 29150-4968 | |
| (803) 774-7546 | |
| (803) 774-9735 |
| Full Name | PH Medical Group Midlands |
|---|---|
| Speciality | Surgery - Plastic And Reconstructive Surgery |
| Location | 115 N Sumter St Ste 115, Sumter, South Carolina |
| Authorized Official Name and Position | Kristi Lawrence (DIRECTOR PROVIDER ENROLLMENT) |
| Authorized Official Contact | 8647976118 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| PH Medical Group Midlands Po Box 743904 Atlanta GA 30374-3904 Ph: (803) 296-7320 | PH Medical Group Midlands 115 N Sumter St Ste 115 Sumter SC 29150-4968 Ph: (803) 774-7546 |
| NPI Number | 1447749510 |
|---|---|
| Provider Enumeration Date | 05/04/2018 |
| Last Update Date | 12/18/2020 |
| Certification Date | 12/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447749510 | NPI | - | NPPES |
| GP8508 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 2086S0122X | Surgery - Plastic And Reconstructive Surgery | (South Carolina) | Primary |
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