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General NPI Number Information
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NPI Number | 1023055688
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Entity Type | Organization
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Legal Business Name | CAROLINA CENTER OF GYNECOLOGICAL ONCOLOGY PA
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 1470 TOBIAS GADSON BLVD SUITE 110
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City | CHARLESTON
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State | SC
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Zip | 29407
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Country | US
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Telephone | 843-556-4380
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Fax | 843-571-5531
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Provider Business Mailing Address
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Address Line | 1470 TOBIAS GADSON BLVD STE 110
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City | CHARLESTON
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State | SC
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Zip | 29407
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Country | US
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Telephone | 843-556-4380
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Fax | 843-571-5531
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS SCOTT JENNINGS
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Credential | MD FACS
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Telephone | 843-556-4380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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