Healthcare Provider Details

I. General information

NPI: 1255666954
Provider Name (Legal Business Name): ALPHA CARE ALLERGY, ASTHMA & IMMUNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 FOLLY RD
CHARLESTON SC
29412-2624
US

IV. Provider business mailing address

PO BOX 12999
CHARLESTON SC
29422-2999
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-3056
  • Fax: 843-762-2488
Mailing address:
  • Phone: 843-795-3056
  • Fax: 843-762-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20328
License Number StateSC

VIII. Authorized Official

Name: MICHAEL L. COON
Title or Position: OWNER
Credential:
Phone: 843-795-3056