Organization

Prisma Health Medical Group-midlands

May also be knows as Ph Oral & Maxillofacial Surgery

Oral & Maxillofacial Surgery (D.M.D.) in Columbia, SC(View on Map)

Legal Business Name

Prisma Health Medical Group-midlands

Also Known As

Ph Oral & Maxillofacial Surgery

NPI Number

1295222503

NPI Type

Organization

Enumeration Date

04/23/2018

Specialties

(Taxonomies)

Code

204E00000X

Primary Taxonomy

Yes

Contact
Information

Purpose

Mailing
Location

Address

PO BOX 743904
3304 FOREST DR

City

Atlanta
Columbia

State

GA
SC

Postal Code

30374-3904
29204-4024

Country

US
US

Telephone Number

(803) 296-7320
(803) 434-6565

Authorized Official

Name

Kristi Lawrence

Title or Position

DIRECTOR PROVIDER ENROLLMENT

Telephone Number

(864) 797-6118

Identifiers

Identifier

ZA8923

Identifier State

SC

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 02/22/2022

Provider Address