Healthcare Provider Details

I. General information

NPI: 1902546179
Provider Name (Legal Business Name): MADISON JAENKE HILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 RUTLEDGE AVE # MSC578
CHARLESTON SC
29425-8903
US

IV. Provider business mailing address

135 RUTLEDGE AVE # MSC578
CHARLESTON SC
29425-8903
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-9155
  • Fax:
Mailing address:
  • Phone: 843-792-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD96746
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: