Healthcare Provider Details

I. General information

NPI: 1932896511
Provider Name (Legal Business Name): MS. CHARLESHA RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8595 PELHAM RD
GREENVILLE SC
29615-5759
US

IV. Provider business mailing address

8595 PELHAM RD
GREENVILLE SC
29615-5759
US

V. Phone/Fax

Practice location:
  • Phone: 864-621-5601
  • Fax: 864-773-3120
Mailing address:
  • Phone: 864-621-5601
  • Fax: 864-773-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberK9J6S4R7
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: