Healthcare Provider Details

I. General information

NPI: 1902513385
Provider Name (Legal Business Name): FREDERICK THOMAS HUTCHINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

200 CHINQUAPIN DR
SUMMERVILLE SC
29485-4593
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-5011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number96327
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: