Healthcare Provider Details

I. General information

NPI: 1184828808
Provider Name (Legal Business Name): CHARLESTON BONE & JOINT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 JOHNNIE DODDS BLVD
MT PLEASANT SC
29464-3027
US

IV. Provider business mailing address

255 E BAY ST
CHARLESTON SC
29401-2632
US

V. Phone/Fax

Practice location:
  • Phone: 843-853-3474
  • Fax: 843-853-3500
Mailing address:
  • Phone: 843-853-3474
  • Fax: 843-853-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DIANNE THESING
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 843-853-3474