| Charleston Adults And Griatrics | |
|
2175 Ashley Phosphate Rd Suite D North Charleston SC 29406-4181 | |
| (843) 764-0770 | |
| (843) 863-0402 |
| Full Name | Charleston Adults And Griatrics |
|---|---|
| Speciality | Internal Medicine |
| Location | 2175 Ashley Phosphate Rd, North Charleston, South Carolina |
| Authorized Official Name and Position | Sara Elizabeth Mayno-hardy (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 8432258320 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charleston Adults And Griatrics Po Box 13955 Charleston SC 29422-3955 Ph: (843) 225-8304 | Charleston Adults And Griatrics 2175 Ashley Phosphate Rd Suite D North Charleston SC 29406-4181 Ph: (843) 764-0770 |
| NPI Number | 1821210121 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 09/09/2019 |
| Medicare PECOS PAC ID | 3870551484 |
|---|---|
| Medicare Enrollment ID | O20041229000640 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821210121 | NPI | - | NPPES |
| GP6738 | Medicaid | SC | |
| GP4032 | Medicaid | SC | |
| P00175892 | Other | SC | RAILROAD MEDICARE PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (South Carolina) | Secondary |
| 207R00000X | Internal Medicine | 13680 (South Carolina) | Primary |
| Provider Name | Allen B Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902866965 PECOS PAC ID: 1759349376 Enrollment ID: I20050105000010 |
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