Healthcare Provider Details

I. General information

NPI: 1871429035
Provider Name (Legal Business Name): KHAZYRA CHARDE' TATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 HOFFMEYER RD STE D
FLORENCE SC
29501-4077
US

IV. Provider business mailing address

2193 BISHOPVILLE HWY
CAMDEN SC
29020-8842
US

V. Phone/Fax

Practice location:
  • Phone: 843-945-1452
  • Fax: 843-945-1489
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17729
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: