Healthcare Provider Details

I. General information

NPI: 1760933451
Provider Name (Legal Business Name): FETTER HEALTH CARE NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 BLACK POND LANE
WADMALAW ISLAND SC
29487
US

IV. Provider business mailing address

51 NASSAU ST
CHARLESTON SC
29403-5513
US

V. Phone/Fax

Practice location:
  • Phone: 843-722-4112
  • Fax: 843-577-8960
Mailing address:
  • Phone: 843-722-4112
  • Fax: 843-577-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ARETHA JONES
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 843-722-4122