Healthcare Provider Details

I. General information

NPI: 1922761337
Provider Name (Legal Business Name): COLIN LEE ECHARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NASSAU ST
CHARLESTON SC
29403-5513
US

IV. Provider business mailing address

1230 JABBERS DR APT 406
MOUNT PLEASANT SC
29464-4498
US

V. Phone/Fax

Practice location:
  • Phone: 843-722-4112
  • Fax:
Mailing address:
  • Phone: 740-851-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4127
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: