Healthcare Provider Details

I. General information

NPI: 1164207379
Provider Name (Legal Business Name): JUSTIN CHRISTOPHER PEARCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOREST DR
COLUMBIA SC
29204-2026
US

IV. Provider business mailing address

1 POSTON RD STE 110
CHARLESTON SC
29407-3457
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-5300
  • Fax: 184-387-6134
Mailing address:
  • Phone: 843-876-1344
  • Fax: 843-876-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29430
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: