Healthcare Provider Details

I. General information

NPI: 1508234675
Provider Name (Legal Business Name): GINNY FORNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 JOHNNIE DODDS BLVD
MT PLEASANT SC
29464-3058
US

IV. Provider business mailing address

6080 OVERLOOK DR
JOHNS ISLAND SC
29455-7652
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-1010
  • Fax: 843-876-2545
Mailing address:
  • Phone: 843-327-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number84457
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: