Healthcare Provider Details

I. General information

NPI: 1194363580
Provider Name (Legal Business Name): EPICENTRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 CHARLIE HALL BLVD
CHARLESTON SC
29414
US

IV. Provider business mailing address

2048 CHARLIE HALL BLVD
CHARLESTON SC
29414
US

V. Phone/Fax

Practice location:
  • Phone: 843-804-6010
  • Fax: 843-804-6011
Mailing address:
  • Phone: 843-804-6010
  • Fax: 843-804-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENOSHA D GLEATON
Title or Position: MD/OWNER
Credential: MD
Phone: 843-804-6010