Organization
FAMILY WELLNESS CENTER OF CHARLESTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANIA DEJESUS (OWNER)
(843) 729-8269
Entity
Organization
Contact information
Practice address
9217 UNIVERSITY BLVD, SUITE C1B, NORTH CHARLESTON, SC 29406-9147
(843) 729-8269
Mailing address
9217 UNIVERSITY BLVD, SUITE C1B, NORTH CHARLESTON, SC 29406-9147
(843) 729-8269
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
LIC-1-15-126877
SC
207Q00000X
Family Medicine Physician
MDO.1175DO
SC
Other
Enumeration date
05/22/2015
Last updated
05/22/2015
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