=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609729086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRACE CHISAM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2026
-----------------------------------------------------
Last Update Date | 02/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 JOHNNIE DODDS BLVD UNIT 121
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29464-2975
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-277-6074
-----------------------------------------------------
Fax | 843-763-7901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 712 SAINT ANDREWS BLVD
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-7141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-766-0871
-----------------------------------------------------
Fax | 843-763-7901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | HAS-0797
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------