Healthcare Provider Details

I. General information

NPI: 1902826050
Provider Name (Legal Business Name): JOSEPH KWESI WANGEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N 8TH AVE SUITE 3A
DILLON SC
29536-2549
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-774-6091
  • Fax: 843-841-3814
Mailing address:
  • Phone: 843-777-7162
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27518
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: