Healthcare Provider Details

I. General information

NPI: 1629693668
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF CHARLESTON, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 OLD GEORGETOWN RD
MT PLEASANT SC
29464-7307
US

IV. Provider business mailing address

125 DOUGHTY ST STE 420
CHARLESTON SC
29403-5741
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-4844
  • Fax: 843-408-4102
Mailing address:
  • Phone: 843-723-3441
  • Fax: 843-805-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: PAM GARMON
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 843-723-3441