Healthcare Provider Details

I. General information

NPI: 1073555983
Provider Name (Legal Business Name): ASHRAF ALI CHATTHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 BERNARDIN AVE SUITE 200
COLUMBIA SC
29204-2039
US

IV. Provider business mailing address

1655 BERNARDIN AVE SUITE 200
COLUMBIA SC
29204-2039
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-1137
  • Fax: 803-256-1138
Mailing address:
  • Phone: 803-256-1137
  • Fax: 803-256-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21213
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number44359
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35099
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: