Healthcare Provider Details

I. General information

NPI: 1013840859
Provider Name (Legal Business Name): JAMES JOHN GORMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 JONATHAN LUCAS ST
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

215 PROMENADE VISTA ST APT 4130
CHARLESTON SC
29412-5133
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-8515
  • Fax:
Mailing address:
  • Phone: 315-717-4839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: