Healthcare Provider Details

I. General information

NPI: 1972138790
Provider Name (Legal Business Name): MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVE
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

PO BOX 931854
ATLANTA GA
31193-1854
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: KARYN RAE
Title or Position: CHIEF
Credential:
Phone: 843-876-1344