Healthcare Provider Details

I. General information

NPI: 1659358976
Provider Name (Legal Business Name): ELAINE EUSTIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 01/10/2024
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 LONG POINT RD STE 407
MT. PLEASANT SC
29464-8298
US

IV. Provider business mailing address

721 LONG POINT RD STE 407
MT. PLEASANT SC
29464-8298
US

V. Phone/Fax

Practice location:
  • Phone: 843-793-9801
  • Fax: 843-936-4972
Mailing address:
  • Phone: 843-793-9801
  • Fax: 843-936-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD33183
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: