# CHARLESTON PEDIATRICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013965474
- **Authorized official:** DR. THOMAS GODFREY QUATTLEBAUM M.D. (PRESIDENT)
- **Authorized official phone:** (843) 723-0855

## Contact information

- **Practice address:** 198 RUTLEDGE AVE, SUITE 1, CHARLESTON, SC 29403-5817
- **Practice address phone:** (843) 723-0855
- **Practice address fax:** (843) 723-1307
- **Mailing address:** 198 RUTLEDGE AVE, SUITE 1, CHARLESTON, SC 29403-5817
- **Mailing address phone:** (843) 723-0855
- **Mailing address fax:** (843) 723-1307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | SC | Yes |

## Other

- **Enumeration date:** 05/05/2006
- **Last updated:** 07/10/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP3608 | — | SC |