Provider Demographics
NPI:1477819761
Name:FOCUS.MD-SC 1002, LLC
Entity Type:Organization
Organization Name:FOCUS.MD-SC 1002, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-804-1901
Mailing Address - Street 1:10 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6301
Mailing Address - Country:US
Mailing Address - Phone:864-248-6393
Mailing Address - Fax:866-731-3760
Practice Address - Street 1:8045 PROVIDENCE RD
Practice Address - Street 2:SUITE 325
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8745
Practice Address - Country:US
Practice Address - Phone:704-804-1901
Practice Address - Fax:833-731-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty