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General NPI Number Information
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NPI Number | 1902232168
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Entity Type | Organization
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Legal Business Name | MEDICAL HOME DEVELOPMENT GROUP
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 1647 BENNING RD NE SUITE 200
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City | WASHINGTON
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State | DC
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Zip | 20002-4569
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Country | US
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Telephone | 843-412-5548
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Fax | 866-643-9237
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Provider Business Mailing Address
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Address Line | 4975 LACROSS RD SUITE 153
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City | N CHARLESTON
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State | SC
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Zip | 29406-6523
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Country | US
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Telephone | 843-412-5548
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Fax | 866-643-9237
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Authorized Official
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Title or Position | CEO
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Name | MRS. AUDREY WHETSELL
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Credential | MS
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Telephone | 843-412-5548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics
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License Number | SCLN12893
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License Number State | SC
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