Healthcare Provider Details

I. General information

NPI: 1710720958
Provider Name (Legal Business Name): COURTNEY NICOLE MCCOOL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY NICOLE SPENCER

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MCCLENNAN BANKS DR
CHARLESTON SC
29401-1164
US

IV. Provider business mailing address

3896 MOSS POINTE CT
JOHNS ISLAND SC
29455-7730
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2300
  • Fax:
Mailing address:
  • Phone: 336-937-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL92370
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: