Healthcare Provider Details

I. General information

NPI: 1194778548
Provider Name (Legal Business Name): LOWCOUNTRY INFECTIOUS DISEASES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 CHARLIE HALL BLVD UNIT B
CHARLESTON SC
29414-6099
US

IV. Provider business mailing address

1938 CHARLIE HALL BLVD UNIT B
CHARLESTON SC
29414-6099
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-0227
  • Fax: 840-402-0232
Mailing address:
  • Phone: 843-402-0227
  • Fax: 840-402-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANNON R MCCOIN
Title or Position: CEO
Credential:
Phone: 843-212-8669