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Organization
LOWCOUNTRY UROLOGY CLINICS, PA
Active
Organization
LOWCOUNTRY UROLOGY CLINICS, PA
Active
Parent organization
LOWCOUNTRY UROLOGY CLINICS, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
LOWCOUNTRY UROLOGY CLINICS, PA
Authorized official
DIANE S HADER (DELEGATED OFFICIAL)
(843) 284-4267
Entity
Organization
Contact information
Practice address
125 DOUGHTY ST, SUITE 770, CHARLESTON, SC 29403-5736
(843) 577-6015
(843) 727-2972
Mailing address
2687 LAKE PARK DR, N CHARLESTON, SC 29406-9100
(843) 725-4414
(843) 725-3118
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4434
—
SC
Enumeration date
08/05/2008
Last updated
04/16/2009
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