Healthcare Provider Details

I. General information

NPI: 1124201702
Provider Name (Legal Business Name): ANNETTE BILTON ANDERSON, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 FOLLY RD SUITE A
CHARLESTON SC
29412-2625
US

IV. Provider business mailing address

418 FOLLY RD SUITE A
CHARLESTON SC
29412-2625
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-5362
  • Fax: 843-266-5133
Mailing address:
  • Phone: 843-795-5362
  • Fax: 843-266-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20379
License Number StateSC

VIII. Authorized Official

Name: ANNETTE BILTON ANDERSON
Title or Position: OWNER
Credential: MD
Phone: 843-795-5362