Healthcare Provider Details

I. General information

NPI: 1487604757
Provider Name (Legal Business Name): CHARLES EFFIONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NASSAU ST
CHARLESTON SC
29403-5513
US

IV. Provider business mailing address

P.O. BOX 31093
CHARLESTON SC
29417
US

V. Phone/Fax

Practice location:
  • Phone: 843-722-4112
  • Fax: 843-577-8960
Mailing address:
  • Phone: 843-573-0499
  • Fax: 843-388-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number19174
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19174
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: