Healthcare Provider Details

I. General information

NPI: 1316218670
Provider Name (Legal Business Name): REMEDY INTERNAL MEDICINE AND WELLNESS CENTER P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 07/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WAPPOO CREEK DR 2A
CHARLESTON SC
29412-2135
US

IV. Provider business mailing address

109 WAPPOO CREEK DR 2A
CHARLESTON SC
29412-2135
US

V. Phone/Fax

Practice location:
  • Phone: 843-737-5206
  • Fax: 843-795-7171
Mailing address:
  • Phone: 843-737-5206
  • Fax: 843-795-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24910
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24910
License Number StateSC

VIII. Authorized Official

Name: DR. SHANNON A KENNEDY
Title or Position: OWNER
Credential: M.D.
Phone: 843-737-5206