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General NPI Number Information
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NPI Number | 1922853332
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Entity Type | Organization
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Legal Business Name | CHARLESTON DIRECT PRIMARY CARE
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 501 HAYES PARK BLVD
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-4952
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Country | US
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Telephone | 434-238-6897
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Fax |
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Provider Business Mailing Address
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Address Line | 2055 UTSEY ST
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-8296
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. KEVIN ANDREW HINSON
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Credential | DO
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Telephone | 434-238-6897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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