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General NPI Number Information
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NPI Number | 1316051345
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Entity Type | Organization
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Legal Business Name | JAMES ISLAND FAMILY PRACTICE
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 490 MARTELLO DR
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City | CHARLESTON
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State | SC
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Zip | 29412-2638
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Country | US
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Telephone | 843-762-4963
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Fax | 843-762-3039
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Provider Business Mailing Address
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Address Line | 490 MARTELLO DR
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City | CHARLESTON
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State | SC
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Zip | 29412-2638
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Country | US
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Telephone | 843-762-4963
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Fax | 843-762-3039
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM D ANDERSON III
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Credential |
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Telephone | 843-762-4963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18074
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License Number State | SC
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