Healthcare Provider Details

I. General information

NPI: 1225577265
Provider Name (Legal Business Name): CORDRAY PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR STE 304
CHARLESTON SC
29414-5743
US

IV. Provider business mailing address

44 FOLLY ROAD BLVD STE C
CHARLESTON SC
29407-7559
US

V. Phone/Fax

Practice location:
  • Phone: 843-718-2334
  • Fax: 843-277-2067
Mailing address:
  • Phone: 843-718-2334
  • Fax: 843-277-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number22185
License Number StateSC

VIII. Authorized Official

Name: DR. TRACY L CORDRAY
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 843-718-2334