| Generations Pediatrics And Internal Medicine | |
|
1483 Tobias Gadson Blvd Ste 101 Charleston SC 29407-4795 | |
| (843) 405-1110 | |
| Not Available |
| Full Name | Generations Pediatrics And Internal Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 1483 Tobias Gadson Blvd Ste 101, Charleston, South Carolina |
| Authorized Official Name and Position | Matthew Justice Kornegay (MANAGING PARTNER) |
| Authorized Official Contact | 8436147953 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Generations Pediatrics And Internal Medicine 1483 Tobias Gadson Blvd Ste 101 Charleston SC 29407-4795 Ph: (843) 405-1110 | Generations Pediatrics And Internal Medicine 1483 Tobias Gadson Blvd Ste 101 Charleston SC 29407-4795 Ph: (843) 405-1110 |
| NPI Number | 1376033829 |
|---|---|
| Provider Enumeration Date | 05/10/2018 |
| Last Update Date | 05/10/2018 |
| Medicare PECOS PAC ID | 8820344591 |
|---|---|
| Medicare Enrollment ID | O20180711000371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376033829 | NPI | - | NPPES |
| 311442 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Matthew J Kornegay |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922042654 PECOS PAC ID: 9032113485 Enrollment ID: I20081112000080 |
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