Basic Information
| Provider Information | |||||||||
| NPI: | 1962731117 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH CAROLINA HIV/AIDS COUNCIL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SC HIV/AIDS COUNCIL | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 CALHOUN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032546644 | ||||||||
| FaxNumber: | 8032542209 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 CALHOUN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032546644 | ||||||||
| FaxNumber: | 8032542209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2009 | ||||||||
| LastUpdateDate: | 12/17/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GADDIST | ||||||||
| AuthorizedOfficialFirstName: | BAMBI | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8032546644 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DRPH | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 42D1011461 | SC | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.