Healthcare Provider Details

I. General information

NPI: 1144388844
Provider Name (Legal Business Name): AMBER SCALLAN HOOVER RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR STE 300E
CHARLESTON SC
29414-5743
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 842-724-2011
  • Fax: 843-606-7991
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number246
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: