Healthcare Provider Details

I. General information

NPI: 1053117424
Provider Name (Legal Business Name): PHILIP HENRY KHOURY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 BEE ST
CHARLESTON SC
29425-8912
US

IV. Provider business mailing address

169 ASHLEY AVE
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-806-6989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL97082
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: