Healthcare Provider Details

I. General information

NPI: 1629577119
Provider Name (Legal Business Name): MICHAEL MAJETIC ADV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SPRINGHALL DR
GOOSE CREEK SC
29445-5335
US

IV. Provider business mailing address

131 SCHULTZ LAKE RD
SUMMERVILLE SC
29483-9117
US

V. Phone/Fax

Practice location:
  • Phone: 843-973-8503
  • Fax:
Mailing address:
  • Phone: 724-513-1549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP10948
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.23998
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: