Healthcare Provider Details

I. General information

NPI: 1235020520
Provider Name (Legal Business Name): SALT MARSH INTERNAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 ASHLEY CROSSING DR STE 165
CHARLESTON SC
29414
US

IV. Provider business mailing address

2270 ASHLEY CROSSING DR STE 165
CHARLESTON SC
29414
US

V. Phone/Fax

Practice location:
  • Phone: 843-936-4455
  • Fax: 843-268-2670
Mailing address:
  • Phone: 843-936-4455
  • Fax: 843-268-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA CHANNELL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 843-936-4455