Healthcare Provider Details

I. General information

NPI: 1154757482
Provider Name (Legal Business Name): TRIDENT PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N HIGHWAY 52
MONCKS CORNER SC
29461-3910
US

IV. Provider business mailing address

9267 MEDICAL PLAZA DR STE G
N CHARLESTON SC
29406-9139
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-3636
  • Fax: 843-797-3637
Mailing address:
  • Phone: 843-797-3636
  • Fax: 843-797-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH EDWARD NOLAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 843-797-3636