Healthcare Provider Details

I. General information

NPI: 1497015135
Provider Name (Legal Business Name): SISTAGIRL MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2012
Last Update Date: 05/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3956 RIVERS AVE
NORTH CHARLESTON SC
29405-7023
US

IV. Provider business mailing address

3956 RIVERS AVE
NORTH CHARLESTON SC
29405-7023
US

V. Phone/Fax

Practice location:
  • Phone: 888-514-3055
  • Fax:
Mailing address:
  • Phone: 888-514-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0048
License Number StateSC

VIII. Authorized Official

Name: MRS. JAYVON DUPREE MUHAMMAD
Title or Position: OWNER/LICENSED MIDWIFE
Credential: CPM
Phone: 888-514-3055