Healthcare Provider Details

I. General information

NPI: 1982037529
Provider Name (Legal Business Name): CHARLESTON ADDICTION MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 ASHLEY PHOSPHATE RD SUITE G
NORTH CHARLESTON SC
29406-4181
US

IV. Provider business mailing address

4255 FABER PLACE DR UNIT 403
NORTH CHARLESTON SC
29405-8574
US

V. Phone/Fax

Practice location:
  • Phone: 843-225-8406
  • Fax: 843-225-8410
Mailing address:
  • Phone: 678-641-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number18976
License Number StateSC

VIII. Authorized Official

Name: MICHAEL J HUGGINS
Title or Position: PRESIDENT
Credential: M. D.
Phone: 678-641-4086