Healthcare Provider Details

I. General information

NPI: 1548324551
Provider Name (Legal Business Name): PULMONARY DISEASES CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 RAOUL WALLENBERG BLVD SUITE B
CHARLESTON SC
29407-3545
US

IV. Provider business mailing address

PO BOX 80054
CHARLESTON SC
29416-0054
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-6646
  • Fax: 843-766-6640
Mailing address:
  • Phone: 843-766-6646
  • Fax: 843-766-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL K. GAME
Title or Position: PRESIDENT
Credential: MD
Phone: 843-766-6646