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General NPI Number Information
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NPI Number | 1134264385
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Entity Type | Individual
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Provider Name | JOHN DAVID STONE IDC
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3600 RIVERS AVE
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-7747
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Country | US
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Telephone | 843-574-8911
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Fax |
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Provider Business Mailing Address
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Address Line | 111 COTILLION CRES
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City | SUMMERVILLE
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State | SC
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Zip | 29483-8148
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Country | US
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Telephone | 843-486-3702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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