Healthcare Provider Details

I. General information

NPI: 1992116834
Provider Name (Legal Business Name): COURTNEY DREW BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 TOBIAS GADSON BLVD STE 110
CHARLESTON SC
29407-4835
US

IV. Provider business mailing address

1470 TOBIAS GADSON BLVD STE 110
CHARLESTON SC
29407-4835
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-4380
  • Fax: 843-571-5531
Mailing address:
  • Phone: 843-556-4380
  • Fax: 843-571-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number83467
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: