Healthcare Provider Details

I. General information

NPI: 1154111284
Provider Name (Legal Business Name): AMITI JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425
US

IV. Provider business mailing address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-0791
  • Fax:
Mailing address:
  • Phone: 843-876-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberLL94895
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: