Provider Demographics
NPI:1962731117
Name:SOUTH CAROLINA HIV/AIDS COUNCIL
Entity type:Organization
Organization Name:SOUTH CAROLINA HIV/AIDS COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BAMBI
Authorized Official - Middle Name:W
Authorized Official - Last Name:GADDIST
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:803-254-6644
Mailing Address - Street 1:1115 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2417
Mailing Address - Country:US
Mailing Address - Phone:803-254-6644
Mailing Address - Fax:803-254-2209
Practice Address - Street 1:1115 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2417
Practice Address - Country:US
Practice Address - Phone:803-254-6644
Practice Address - Fax:803-254-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42D1011461291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory