Healthcare Provider Details

I. General information

NPI: 1548604275
Provider Name (Legal Business Name): GABRIEL RYAN CHEDISTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CALLEN BLVD STE 220
SUMMERVILLE SC
29486-2816
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-958-1281
  • Fax: 843-958-1278
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35767
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: