# PARKWOOD PEDIATRIC GROUP PA

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

## Provider details

- **NPI number:** 1659521201
- **Authorized official:** MR. CHARLES W KISABETH M.D. (PHYSICIAN)
- **Authorized official phone:** (843) 266-7636

## Contact information

- **Practice address:** 1243 SAVANNAH HWY, CHARLESTON, SC 29407-7817
- **Practice address phone:** (843) 556-8110
- **Practice address fax:** (843) 556-8112
- **Mailing address:** 1243 SAVANNAH HWY, CHARLESTON, SC 29407-7817
- **Mailing address phone:** (843) 556-8110
- **Mailing address fax:** (843) 556-8112

## Taxonomy

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

## Other

- **Enumeration date:** 09/19/2008
- **Last updated:** 09/19/2008