Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 4310 | SC |
NPI | 1023652021 |
---|---|
Provider Name | Mr. Steven Scott Childress JR. |
First Address | Murrells Inlet, SC 29576-9356 |
Second Address | Murrells Inlet, SC 29576-9356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2019 |
Last Update Date | 01/11/2019 |