Healthcare Provider Details

I. General information

NPI: 1487652442
Provider Name (Legal Business Name): ADVANCED DIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WELLNESS BLVD STE 105
IRMO SC
29063-2872
US

IV. Provider business mailing address

1 WELLNESS BLVD STE 105
IRMO SC
29063-2872
US

V. Phone/Fax

Practice location:
  • Phone: 803-419-4235
  • Fax: 803-419-4236
Mailing address:
  • Phone: 803-419-4235
  • Fax: 803-419-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL P BOUKNIGHT
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 803-888-2282