Healthcare Provider Details

I. General information

NPI: 1336453083
Provider Name (Legal Business Name): PHYSICIANS HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 DORCHESTER MANOR BLVD
NORTH CHARLESTON SC
29420-8108
US

IV. Provider business mailing address

283 DORCHESTER MANOR BLVD
NORTH CHARLESTON SC
29420-8108
US

V. Phone/Fax

Practice location:
  • Phone: 843-552-8000
  • Fax: 842-552-0093
Mailing address:
  • Phone: 843-552-8000
  • Fax: 842-552-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN E QUATTLEBAUM
Title or Position: OWNER
Credential: D.C.
Phone: 843-552-8000