Healthcare Provider Details

I. General information

NPI: 1801992961
Provider Name (Legal Business Name): TRIDENT PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9267 MEDICAL PLAZA DR STE G
N CHARLESTON SC
29406-9139
US

IV. Provider business mailing address

9267 MEDICAL PLAZA DR STE G
N CHARLESTON SC
29406-9139
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-3636
  • Fax: 843-797-3637
Mailing address:
  • Phone: 843-797-3636
  • Fax: 843-797-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH EDWARD NOLAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 843-797-3636