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Candyce S. Mcleod

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NPI Number Detailed Information

Provider Information:

Name: Candyce S. Mcleod
Gender: F
Provider License Number If Given: 45938

NPI Information:

NPI: 1730188277
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 12/8/2015

Provider Business Mailing Address:

Address: 1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
Columbia, SC 29201
Phone Number: 8034540365
Fax Number: 8034046000

Provider Business Practice Location Address:

Address: 9302 MEDICAL PLAZA DRIVE, SUITE C LTC HEALTH SOLUTIONS
Charleston, SC 29406
Phone Number: 8437970416
Fax Number: 8438474477

Provider Taxonomy:

Primary: 164W00000X
Secondary (if any): 363LF0000X
State: SC

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