| Nu South Providers LLC | |
|
117 North Highway 52 Unit 56 Moncks Corner SC 29461-0056 | |
| (843) 900-7098 | |
| Not Available |
| Full Name | Nu South Providers LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 117 North Highway 52, Moncks Corner, South Carolina |
| Authorized Official Name and Position | Kimberly Davis (CREDENTIALING SPECIALISTS) |
| Authorized Official Contact | 9123734385 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nu South Providers LLC Po Box 56 Moncks Corner SC 29461-0056 Ph: (843) 900-7098 | Nu South Providers LLC 117 North Highway 52 Unit 56 Moncks Corner SC 29461-0056 Ph: (843) 900-7098 |
| NPI Number | 1144038274 |
|---|---|
| Provider Enumeration Date | 12/20/2024 |
| Last Update Date | 12/24/2024 |
| Certification Date | 12/24/2024 |
| Medicare PECOS PAC ID | 6709382690 |
|---|---|
| Medicare Enrollment ID | O20250930002810 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144038274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Christina Matthews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467984450 PECOS PAC ID: 5294006714 Enrollment ID: I20190422002127 |
| Provider Name | Kimberly Nicole Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356717276 PECOS PAC ID: 4183928526 Enrollment ID: I20211206002174 |
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