| |
1483 Tobias Gadson Blvd Suite 206 Charleston SC 29407-8702 | |
(843) 766-1936 | |
(843) 766-1206 |
Full Name | |
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Speciality | Family Medicine |
Location | 1483 Tobias Gadson Blvd, Charleston, South Carolina |
Authorized Official Name and Position | Sara Elizabeth Maynor-hardy (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 8432258320 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 13955 Charleston SC 29422-3955 Ph: (843) 225-8304 | 1483 Tobias Gadson Blvd Suite 206 Charleston SC 29407-8702 Ph: (843) 766-1936 |
NPI Number | 1881639862 |
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Provider Enumeration Date | 06/16/2006 |
Last Update Date | 10/21/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881639862 | NPI | - | NPPES |
GP3558 | Medicaid | SC | |
GP6738 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | SC0310 (South Carolina) | Secondary |
207Q00000X | Family Medicine | (South Carolina) | Primary |
Palmetto Primary Care Physicians, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2097 Henry Tecklenburg Dr, Charleston, SC 29414 Phone: 843-572-7727 Fax: 843-569-5881 | |
Harold R Nicolette, Do, Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6 Carriage Ln, Suite B, Charleston, SC 29407 Phone: 843-766-4100 Fax: 843-571-4177 | |
Empowerme Medical Group, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2333 Ashley River Rd, Charleston, SC 29414 Phone: 877-367-9772 | |
Medical University Of South Carolina Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 60 Barre St, Charleston, SC 29401 Phone: 901-292-7077 |