Healthcare Provider Details

I. General information

NPI: 1700990231
Provider Name (Legal Business Name): ASSOCIATED FOOT SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2097 HENRY TECKLENBURG DR SUITE 210W
CHARLESTON SC
29414-5740
US

IV. Provider business mailing address

2097 HENRY TECKLENBURG DR SUITE 210W
CHARLESTON SC
29414-5740
US

V. Phone/Fax

Practice location:
  • Phone: 843-852-9444
  • Fax: 843-852-9404
Mailing address:
  • Phone: 843-852-9444
  • Fax: 843-852-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number104
License Number StateSC

VIII. Authorized Official

Name: CHARLES J GUDAS
Title or Position: PRESIDENT
Credential: DPM
Phone: 843-852-9444