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General NPI Number Information
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NPI Number | 1932595816
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Entity Type | Organization
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Legal Business Name | MAGNOLIA DERMATOLOGY, LLC
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 48 FOLLY ROAD BLVD
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City | CHARLESTON
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State | SC
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Zip | 29407-7507
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Country | US
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Telephone | 843-769-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 48 FOLLY ROAD BLVD
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City | CHARLESTON
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State | SC
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Zip | 29407-7507
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Country | US
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Telephone | 843-769-2100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH N MYERS JR.
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Credential |
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Telephone | 843-769-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD31744
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License Number State | SC
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