Healthcare Provider Details

I. General information

NPI: 1255063640
Provider Name (Legal Business Name): JULIA WILSON RODES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2022
Last Update Date: 06/26/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PRESIDENT ST
CHARLESTON SC
29425-5712
US

IV. Provider business mailing address

67 PRESIDENT ST # 865
CHARLESTON SC
29425-5712
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-9162
  • Fax:
Mailing address:
  • Phone: 843-792-9162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL88341
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: