Healthcare Provider Details

I. General information

NPI: 1104314251
Provider Name (Legal Business Name): ZACHARY STEPHEN HUBBARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL
CHARLESTON SC
29425
US

IV. Provider business mailing address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-5053
  • Fax:
Mailing address:
  • Phone: 843-876-5053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number336170-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: