Provider Demographics
NPI:1649623653
Name:WOODS BAY FAMILY CARE LLC
Entity type:Organization
Organization Name:WOODS BAY FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MAXIE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:III
Authorized Official - Credentials:APRN FNP-C
Authorized Official - Phone:843-616-3410
Mailing Address - Street 1:128 E BAKER ST
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:SC
Mailing Address - Zip Code:29114-9101
Mailing Address - Country:US
Mailing Address - Phone:843-616-3410
Mailing Address - Fax:866-707-4980
Practice Address - Street 1:128 E BAKER ST
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:SC
Practice Address - Zip Code:29114-9101
Practice Address - Country:US
Practice Address - Phone:843-616-3410
Practice Address - Fax:866-707-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care