Provider Demographics
NPI:1538766712
Name:ST JAMES HEALTH AND WELLNESS INC
Entity type:Organization
Organization Name:ST JAMES HEALTH AND WELLNESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-990-7993
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29458-0608
Mailing Address - Country:US
Mailing Address - Phone:843-887-3274
Mailing Address - Fax:843-887-3817
Practice Address - Street 1:411 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-4011
Practice Address - Country:US
Practice Address - Phone:843-264-1223
Practice Address - Fax:843-264-1227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JAMES SANTEE FAMILY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-01
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
048430OtherCHC