Basic Information
| Provider Information | |||||||||
| NPI: | 1245643212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FALL PREVENTION ALLIANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1739 MAYBANK HWY | ||||||||
| Address2: | SUITE T-612 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294122103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434943744 | ||||||||
| FaxNumber: | 8445843469 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 FOLLY RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294122625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437955362 | ||||||||
| FaxNumber: | 8445843469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2014 | ||||||||
| LastUpdateDate: | 07/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | LELAND | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | MIKELL | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8434943744 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.