Healthcare Provider Details

I. General information

NPI: 1801469556
Provider Name (Legal Business Name): HANNAH E MOORHEAD DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9313 MEDICAL PLAZA DR STE 202
CHARLESTON SC
29406-9176
US

IV. Provider business mailing address

9313 MEDICAL PLAZA DR STE 202
CHARLESTON SC
29406-9176
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-1200
  • Fax: 843-553-0424
Mailing address:
  • Phone: 843-572-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25213
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: