Healthcare Provider Details

I. General information

NPI: 1922853332
Provider Name (Legal Business Name): CHARLESTON DIRECT PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 HAYES PARK BLVD
JOHNS ISLAND SC
29455-4952
US

IV. Provider business mailing address

2055 UTSEY ST
JOHNS ISLAND SC
29455-8296
US

V. Phone/Fax

Practice location:
  • Phone: 434-238-6897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN ANDREW HINSON
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 434-238-6897