Healthcare Provider Details

I. General information

NPI: 1932367927
Provider Name (Legal Business Name): CHARLESTON ENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 SAVAGE RD
CHARLESTON SC
29407-4726
US

IV. Provider business mailing address

1849 SAVAGE RD
CHARLESTON SC
29407-4726
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-7103
  • Fax:
Mailing address:
  • Phone: 843-766-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3896
License Number StateSC

VIII. Authorized Official

Name: MR. MICHAEL M. GRUBB
Title or Position: CEO
Credential: MS MBA
Phone: 843-766-7103