Healthcare Provider Details

I. General information

NPI: 1003092909
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALISTS OF CHARLESTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR SUITE 200
CHARLESTON SC
29414-5741
US

IV. Provider business mailing address

PO BOX 601813
CHARLOTTE NC
28260-1813
US

V. Phone/Fax

Practice location:
  • Phone: 843-958-2500
  • Fax: 843-958-2680
Mailing address:
  • Phone: 843-958-2500
  • Fax: 843-856-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0431230004
License Number StateSC

VIII. Authorized Official

Name: DR. JOHN M GRAHAM JR.
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 843-958-2500