NPI 1104259340

South Carolina Department of Corrections

Organisation General Practice Physician Columbia, SC

Practice location

Address: 4444 Broad River Rd, Columbia, SC 29210-4012
Phone: (803) 896-2707
Mailing address: 4444 Broad River Rd P. O. Box 21787, Columbia, SC 29210-4012

Authorised official

Name: John Branham Tomarchio
Title: Medical Director
Phone: (803) 896-1233

Registered specialties

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence 33514 (SC)

Other General Practice providers in South Carolina →

Registry record

NPI: 1104259340
Entity type: Organization
NPI issued: 12 Aug 2013
Record last updated: 12 Aug 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.