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Southeastern Medical Group, Llc
Specialist in Lexington, South Carolina
NPI 1093729386

Southeastern Medical Group, Llc is a Specialist based in Lexington, SC. Southeastern Medical Group, Llc practices in Lexington, SC. The NPI Number for Southeastern Medical Group, Llc is 1093729386 and holds a License No. 17764 (South Carolina).

The current practice location address for Southeastern Medical Group, Llc is 609 South Lake Dr, Lexington, SC and can be reached out via phone at 803-957-0770 and via fax at 803-957-0909. You can also correspond with Southeastern Medical Group, Llc through the mailing address at 609 SOUTH LAKE DR, LEXINGTON, SC - 29072-4119 (mailing address contact number: 803-957-0770).

Location: 609 South Lake Dr, Lexington, SC, 29072-4119
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1093729386
Provider Name
Southeastern Medical Group, Llc
Credential
Provider Entity Type
Organization
Address
609 South Lake Dr, Lexington, SC, 29072-4119
Phone Number
803-957-0770
Fax Number
803-957-0909
Provider Enumeration Date
07/29/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1386645596 01 SC DR. OMOIGUI IND NPI #
17764 01 SC SC MEDICAL LICENSE #
$$$$$$$$$ 01 SC DR. OMOIGUI SSN
institution
Provider Business Practice Location Address Details
Address
609 South Lake Dr
City
Lexington
State
South Carolina
Zip
29072-4119
Phone Number
803-957-0770
Fax Number
803-957-0909
person
Provider Business Mailing Address Details
Address
609 South Lake Dr
City
Lexington
State
South Carolina
Zip
29072-4119
Phone Number
803-957-0770
Fax Number
803-957-0909
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
17764 (South Carolina)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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