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General NPI Number Information
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NPI Number | 1134219223
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Entity Type | Organization
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Legal Business Name | SOUTH CAROLINA NEPHROLOGY AND HYPERTENSION
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 3709 MAGNOLIA ST
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City | ORANGEBURG
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State | SC
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Zip | 29118-1403
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Country | US
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Telephone | 803-531-2220
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Fax | 803-531-7975
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Provider Business Mailing Address
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Address Line | PO BOX 2981
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City | ORANGEBURG
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State | SC
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Zip | 29116-2981
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Country | US
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Telephone | 803-531-2220
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Fax | 803-531-7975
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOUSTAFA A MOUSTAFA
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Credential | M.D.
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Telephone | 803-531-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 17881
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License Number State | SC
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