Healthcare Provider Details

I. General information

NPI: 1972778652
Provider Name (Legal Business Name): JENNINGS ELLIOTT NESTOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

4002 COLONEL VANDERHORST CIR
MOUNT PLEASANT SC
29466-8043
US

V. Phone/Fax

Practice location:
  • Phone: 304-685-7074
  • Fax: 843-847-4843
Mailing address:
  • Phone: 304-685-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number201302335
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: