Healthcare Provider Details

I. General information

NPI: 1023503315
Provider Name (Legal Business Name): 1800DOCTORB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 WESCOTT BLVD
SUMMERVILLE SC
29485-9043
US

IV. Provider business mailing address

1061 RIVERSHORE RD
CHARLESTON SC
29492-7980
US

V. Phone/Fax

Practice location:
  • Phone: 843-486-2712
  • Fax:
Mailing address:
  • Phone: 267-226-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1631
License Number StateSC

VIII. Authorized Official

Name: DR. CORYNNE ANN BOYER
Title or Position: DIRECTOR
Credential: DO
Phone: 267-226-0250