Healthcare Provider Details

I. General information

NPI: 1508921750
Provider Name (Legal Business Name): CHARLESTON NEUROLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9313 MEDICAL PLAZA DR SUITE 310
CHARLESTON SC
29406-9155
US

IV. Provider business mailing address

9313 MEDICAL PLAZA DR SUITE 310
CHARLESTON SC
29406-9155
US

V. Phone/Fax

Practice location:
  • Phone: 843-569-1856
  • Fax: 843-569-1879
Mailing address:
  • Phone: 843-569-1856
  • Fax: 843-569-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12363
License Number StateSC

VIII. Authorized Official

Name: DR. JOHN WILLIAMS PLYLER
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 843-725-3530