Healthcare Provider Details

I. General information

NPI: 1255367322
Provider Name (Legal Business Name): TARA M JOHNSON HUGHES P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 LEONARD FULGHUM DR STE 100
MOUNT PLEASANT SC
29464-3793
US

IV. Provider business mailing address

PO BOX 13955
CHARLESTON SC
29422-3955
US

V. Phone/Fax

Practice location:
  • Phone: 843-849-1300
  • Fax:
Mailing address:
  • Phone: 843-572-8201
  • Fax: 843-797-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA812
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number812
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number812
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: