Healthcare Provider Details

I. General information

NPI: 1487344164
Provider Name (Legal Business Name): JOSHUA CALDERON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 MAYBANK HWY
JOHNS ISLAND SC
29455-4819
US

IV. Provider business mailing address

PO BOX 602108
CHARLOTTE NC
28260-2108
US

V. Phone/Fax

Practice location:
  • Phone: 843-985-6292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL89925
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: