Healthcare Provider Details

I. General information

NPI: 1538272703
Provider Name (Legal Business Name): LOWCOUNTRY ENDOCRINE & DIABETES ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST SUITE 530
CHARLESTON SC
29403-5736
US

IV. Provider business mailing address

125 DOUGHTY ST STE 530
CHARLESTON SC
29403-5744
US

V. Phone/Fax

Practice location:
  • Phone: 843-805-5918
  • Fax:
Mailing address:
  • Phone: 843-805-5918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number16440
License Number StateSC

VIII. Authorized Official

Name: KIMBERLY B PUGH
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 843-805-5918