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General NPI Number Information
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NPI Number | 1013280650
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Entity Type | Organization
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Legal Business Name | MT. PLEASANT PSYCHIATRY LLC
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 874 WHIPPLE RD STE 200
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City | MT PLEASANT
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State | SC
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Zip | 29464-8901
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Country | US
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Telephone | 843-400-4089
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Fax | 877-832-2114
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Provider Business Mailing Address
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Address Line | 874 WHIPPLE RD STE 200
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City | MT PLEASANT
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State | SC
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Zip | 29464-8901
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Country | US
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Telephone | 843-400-4089
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Fax | 877-832-2114
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. RICHARD CANNON PHELPS II
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Credential | D.O.
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Telephone | 843-400-4089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | SC1442.MDO
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License Number State | SC
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