Healthcare Provider Details

I. General information

NPI: 1043292576
Provider Name (Legal Business Name): SARAH E RELYEA-LOGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH E BRADFORD MD

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 FRESHFIELDS DR STE J101
JOHNS ISLAND SC
29455-5443
US

IV. Provider business mailing address

21 GEORGE ST STE 100
CHARLESTON SC
29401-1489
US

V. Phone/Fax

Practice location:
  • Phone: 843-768-4800
  • Fax: 843-606-8039
Mailing address:
  • Phone: 843-779-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39035
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101-236413
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: