Healthcare Provider Details

I. General information

NPI: 1184132193
Provider Name (Legal Business Name): SOUTH CAROLINA NEURO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 LEINBACH DRIVE D4
CHARLESTON SC
29407-7086
US

IV. Provider business mailing address

29 LEINBACH DRIVE D4
CHARLESTON SC
29407-7086
US

V. Phone/Fax

Practice location:
  • Phone: 843-509-6521
  • Fax: 843-636-3406
Mailing address:
  • Phone: 843-509-6521
  • Fax: 843-636-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM HOWARD BUDDIN JR.
Title or Position: OWNER
Credential: PHD
Phone: 843-860-5266