Healthcare Provider Details

I. General information

NPI: 1184249716
Provider Name (Legal Business Name): JOSHUA DAVID MIXSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 07/18/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-8908
US

IV. Provider business mailing address

135 RUTLEDGE AVE 12TH FLOOR, MSC 591
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number84282
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: