Healthcare Provider Details

I. General information

NPI: 1396776670
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF CHARLESTON, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 GARDNER ROAD STE 112
CHARLESTON SC
29407-5768
US

IV. Provider business mailing address

125 DOUGHTY ST STE 420
CHARLESTON SC
29403-5741
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-3441
  • Fax: 843-805-4040
Mailing address:
  • Phone: 843-723-3441
  • Fax: 843-805-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAM PERRY
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 843-723-3441