Healthcare Provider Details

I. General information

NPI: 1760417141
Provider Name (Legal Business Name): NEUROLOGY NEUROSURGERY CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST SUITE 570
CHARLESTON SC
29403-5744
US

IV. Provider business mailing address

125 DOUGHTY ST SUITE 570
CHARLESTON SC
29403-5744
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-8967
  • Fax: 843-577-6093
Mailing address:
  • Phone: 843-723-8967
  • Fax: 843-577-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: WARD CURTIS WORTHINGTON
Title or Position: PARTNER
Credential: M.D.
Phone: 843-723-8967