MEDICARE: BARRIER ISLANDS PSYCHIATRY P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1981	SC
2	2084P0800X	Psychiatry Physician	22098	SC

General Provider Information

NPI Number	:	1952517229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRIER ISLANDS PSYCHIATRY P A

Provider Business Mailing Address
First Line	:	1620 ASHLEY RIVER RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5983
Country	:	US
Telephone Number	:	843-556-8177
Fax Number	:	843-571-2742

Provider Business Practice Location Address
First Line	:	1616 ASHLEY RIVER RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5902
Country	:	US
Telephone Number	:	843-556-8177
Fax Number	:	843-571-2742

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CONSTANCE J. ALEXANDER
Credential	:	M. D.
Telephone Number	:	843-556-8177

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/10/2024

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