Healthcare Provider Details

I. General information

NPI: 1952515132
Provider Name (Legal Business Name): A DOCTOR ON CALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 PALM BLVD
ISLE OF PALMS SC
29451-2296
US

IV. Provider business mailing address

1202 PALM BLVD
ISLE OF PALMS SC
29451-2296
US

V. Phone/Fax

Practice location:
  • Phone: 843-886-4402
  • Fax: 843-886-4430
Mailing address:
  • Phone: 843-886-4402
  • Fax: 843-886-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number131146SC
License Number StateSC

VIII. Authorized Official

Name: DR. KATHLEEN R MALANEY
Title or Position: CORPORATE OFFICER
Credential: M.D.
Phone: 843-886-4402