Healthcare Provider Details

I. General information

NPI: 1790274363
Provider Name (Legal Business Name): DAVID PIERCE MYSONA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-4220
US

IV. Provider business mailing address

171 ASHLEY AVE
CHARLESTON SC
29425-0100
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number239396
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number93998
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: