Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 10451 | SC |
NPI | 1053720417 |
---|---|
Provider Name | Dr. Ralph Mckeetha Shealy |
First Address | Mount Pleasant, SC 29466-7930 |
Second Address | Mount Pleasant, SC 29466-7930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2014 |
Last Update Date | 10/08/2014 |