Healthcare Provider Details

I. General information

NPI: 1164006508
Provider Name (Legal Business Name): JONATHAN LANSON PLYLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

333 SOUTH COLUMBIA STREET 126 MACNIDER HALL CB 7005
CHAPEL HILL NC
27599-7005
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2000
  • Fax:
Mailing address:
  • Phone: 919-966-1043
  • Fax: 919-843-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMMD.91815
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: