Healthcare Provider Details

I. General information

NPI: 1205299971
Provider Name (Legal Business Name): NICOLE GONG JAWITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST STE 280
CHARLESTON SC
29403-5727
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-720-8369
  • Fax: 843-720-8370
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number97137
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: