Healthcare Provider Details

I. General information

NPI: 1326809013
Provider Name (Legal Business Name): JONATHAN PLOEGER MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W MONTAGUE AVE STE 104
NORTH CHARLESTON SC
29418-6083
US

IV. Provider business mailing address

106 GREGOR MENDEL CIR
GREENWOOD SC
29646-2315
US

V. Phone/Fax

Practice location:
  • Phone: 843-746-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number308
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: