| Organization Name: | EXCELSIOR MEDICAL CLINIC, PA |
| NPI Number: | 1588618144 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH CECIL WILLIAMS (PRESIDENT) |
| Mailing Address: | 448 N Main St Excelsior Medical Clinic, Pa Sumter |
| State: | SC US |
| Postal Code: | 291504233 |
| Phone Number: | 8037782429 |
| Fax Number: | 8037736303 |
| NPI Enumeration Date: | 05/19/2006 |
| NPI Last Update Date: | 10/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 9646 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |