Healthcare Provider Details

I. General information

NPI: 1396465043
Provider Name (Legal Business Name): GRACEFUL HARMONY MEDSPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 ASHLEY PHOSPHATE RD STE A
NORTH CHARLESTON SC
29418-4403
US

IV. Provider business mailing address

2850 ASHLEY PHOSPHATE RD STE A
NORTH CHARLESTON SC
29418-4403
US

V. Phone/Fax

Practice location:
  • Phone: 843-817-1744
  • Fax:
Mailing address:
  • Phone: 843-817-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: TABIA ONI MCMULLEN
Title or Position: CEO
Credential: NP
Phone: 843-817-1744