Healthcare Provider Details

I. General information

NPI: 1477677201
Provider Name (Legal Business Name): WILLIAM MICHAEL DONOVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9326 MEDICAL PLAZA DR STE B
CHARLESTON SC
29406-9138
US

IV. Provider business mailing address

9326 MEDICAL PLAZA DR STE B
CHARLESTON SC
29406-9138
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-7070
  • Fax:
Mailing address:
  • Phone: 843-553-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number90655
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: