Healthcare Provider Details

I. General information

NPI: 1316025745
Provider Name (Legal Business Name): JOHN THOMAS HULVEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 MEDCOM STREET SOUTH CAROLINA SPORTS MEDICINE
CHARLESTON SC
29406
US

IV. Provider business mailing address

135 PIER VIEW ST UNIT 401
DANIEL ISLAND SC
29492-8453
US

V. Phone/Fax

Practice location:
  • Phone: 843-414-6966
  • Fax:
Mailing address:
  • Phone: 843-330-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number27844
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: