Healthcare Provider Details

I. General information

NPI: 1922505676
Provider Name (Legal Business Name): DANIEL POOLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8091 RIVERS AVE
NORTH CHARLESTON SC
29406-9236
US

IV. Provider business mailing address

1818 HENDERSON ST
COLUMBIA SC
29201-2619
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-7000
  • Fax:
Mailing address:
  • Phone: 803-782-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101279918
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number93979
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number333412
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number333412
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: