Healthcare Provider Details

I. General information

NPI: 1053590836
Provider Name (Legal Business Name): ATLANTIC OCCUPATIONAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 W MONTAGUE AVE
N CHARLESTON SC
29418-5942
US

IV. Provider business mailing address

3625 W MONTAGUE AVE
N CHARLESTON SC
29418-5942
US

V. Phone/Fax

Practice location:
  • Phone: 843-207-7130
  • Fax: 843-207-8633
Mailing address:
  • Phone: 843-207-7130
  • Fax: 843-207-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENT KOLANKO
Title or Position: VP - OPERATIONS
Credential:
Phone: 843-207-7130