Healthcare Provider Details

I. General information

NPI: 1942258561
Provider Name (Legal Business Name): ANNE LOUISE EDWARDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CHARLIE HALL BLVD STE A
CHARLESTON SC
29414-6066
US

IV. Provider business mailing address

2060 CHARLIE HALL BLVD STE A
CHARLESTON SC
29414-6066
US

V. Phone/Fax

Practice location:
  • Phone: 843-483-0193
  • Fax: 839-213-4599
Mailing address:
  • Phone: 843-483-0193
  • Fax: 839-213-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number16959
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: