Healthcare Provider Details

I. General information

NPI: 1477509404
Provider Name (Legal Business Name): HENRY AYIKU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 FABER PLACE DR
NORTH CHARLESTON SC
29405-8533
US

IV. Provider business mailing address

1481 TOBIAS GADSON BLVD SUITE 2A
CHARLESTON SC
29407-4794
US

V. Phone/Fax

Practice location:
  • Phone: 843-767-9312
  • Fax: 843-767-9313
Mailing address:
  • Phone: 843-766-5633
  • Fax: 843-766-5634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number23994
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number23994
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: