Provider Information for 1619461001
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STUART WORLEY
Sex: Female
NPI: 1619461001
Last Updated: 2018-06-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1619461001 | ||||||||
| Enumeration Date | 2018-06-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 186 BRIANS LAKE RD MOUNTAIN REST, SC 29664-9111 United States Phone: 704-576-5648 | Fax: | ||||||||
| Primary Practice Address | 186 BRIANS LAKE RD MOUNTAIN REST, SC 29664-9111 United States Phone: 704-576-5648 | Fax: | ||||||||
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