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General NPI Number Information
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NPI Number | 1356546170
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Entity Type | Organization
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Legal Business Name | WEST ASHLEY OBGYN PA
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 1843 ASHLEY RIVER RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4740
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Country | US
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Telephone | 843-769-4424
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Fax | 843-769-4425
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Provider Business Mailing Address
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Address Line | 1843 ASHLEY RIVER RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4740
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Country | US
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Telephone | 843-769-4424
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Fax | 843-769-4425
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. AGNES OYIBOKJA MUGHELLI
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Credential |
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Telephone | 843-769-4424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 14683
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License Number State | SC
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