Healthcare Provider Details

I. General information

NPI: 1750462701
Provider Name (Legal Business Name): LIBERTY SLEEP ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 FOLLY RD SUITE D
CHARLESTON SC
29412-2625
US

IV. Provider business mailing address

418 FOLLY RD SUITE D
CHARLESTON SC
29412-2625
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-5553
  • Fax: 843-795-2262
Mailing address:
  • Phone: 843-795-5553
  • Fax: 843-795-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HUGH D DURRENCE
Title or Position: MANAGING MEMBER
Credential: R.PH, M.D.
Phone: 843-795-5362