=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265654529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAVENEL OB-GYN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 10/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1370 REMOUNT ROAD SUITE D
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-566-1200
-----------------------------------------------------
Fax | 843-566-0401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | POST OFFICE BOX 60730
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29419-0730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-566-1200
-----------------------------------------------------
Fax | 843-566-1224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. FRANCIS AKOM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 843-566-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 019439
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------