Healthcare Provider Details

I. General information

NPI: 1063408979
Provider Name (Legal Business Name): MT PLEASANT FAMILY PRACTICE,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BOWMAN RD SUITE 203
MT PLEASANT SC
29464-3203
US

IV. Provider business mailing address

900 BOWMAN RD SUITE 203
MT PLEASANT SC
29464-3203
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-1341
  • Fax: 843-884-1345
Mailing address:
  • Phone: 843-884-1341
  • Fax: 843-884-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON ROGERS OWENS
Title or Position: MANAGER
Credential:
Phone: 843-884-1341