Healthcare Provider Details

I. General information

NPI: 1124693502
Provider Name (Legal Business Name): ALEXIS ANN VIOLETTE OGBONNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS ANN VIOLETTE MD

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST STE 210 MSC 323
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

96 JONATHAN LUCAS ST STE 210 MSC 323
CHARLESTON SC
29425-8900
US

V. Phone/Fax

Practice location:
  • Phone: 859-608-4375
  • Fax:
Mailing address:
  • Phone: 859-608-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number86121
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86121
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: