Healthcare Provider Details

I. General information

NPI: 1881754513
Provider Name (Legal Business Name): DURST FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 STATION 22 12
SULLIVANS ISLAND SC
29482-9768
US

IV. Provider business mailing address

306 STATION 22 1/2
SULLIVANS ISLAND SC
29483-9768
US

V. Phone/Fax

Practice location:
  • Phone: 843-883-3176
  • Fax: 843-883-3459
Mailing address:
  • Phone: 843-883-3176
  • Fax: 843-883-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: WANDA BROWN
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-883-3176