Provider Demographics
NPI:1851008106
Name:PEE DEE REGIONAL HOSPITAL FOR GERIATRIC BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:PEE DEE REGIONAL HOSPITAL FOR GERIATRIC BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-440-7215
Mailing Address - Street 1:1122 LADY STREET 3D FLOOR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:919-440-7215
Mailing Address - Fax:
Practice Address - Street 1:1138 CHERAW ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2466
Practice Address - Country:US
Practice Address - Phone:919-440-7215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty