Healthcare Provider Details

I. General information

NPI: 1528355658
Provider Name (Legal Business Name): JOHN PHILLIPS HUNGERFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2011
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

169 ASHLEY AVE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-0337
  • Fax:
Mailing address:
  • Phone: 843-792-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberLL 34766
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34766
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: