Healthcare Provider Details

I. General information

NPI: 1578626552
Provider Name (Legal Business Name): CHARLESTON WOMENS WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 PARKSHIRE WAY
CHARLESTON SC
29418-2102
US

IV. Provider business mailing address

5319 PARKSHIRE WAY
CHARLESTON SC
29418-2102
US

V. Phone/Fax

Practice location:
  • Phone: 843-767-2121
  • Fax: 843-767-2102
Mailing address:
  • Phone: 843-767-2121
  • Fax: 843-767-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20332
License Number StateSC

VIII. Authorized Official

Name: DR. PAULA ORR
Title or Position: PHYSICIAN
Credential: MD
Phone: 843-767-2121