Healthcare Provider Details

I. General information

NPI: 1487276580
Provider Name (Legal Business Name): JOHN DAVISON SCHULTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 S ALLIANCE DR STE 111B
GOOSE CREEK SC
29445-7296
US

IV. Provider business mailing address

9100 MEDCOM ST
NORTH CHARLESTON SC
29406-9167
US

V. Phone/Fax

Practice location:
  • Phone: 843-971-9350
  • Fax:
Mailing address:
  • Phone: 843-572-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3561
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: