Healthcare Provider Details

I. General information

NPI: 1184402448
Provider Name (Legal Business Name): FEYIKEMI OGUNFUWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST CSB 210, MSC 323
CHARLESTON SC
29425-5148
US

IV. Provider business mailing address

96 JONATHAN LUCAS ST CSB 210 MSC 323
CHARLESTON SC
29425-0001
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberLL94698
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: