Organization
CHARLESTON PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS GODFREY QUATTLEBAUM M.D. (PRESIDENT)
(843) 723-0855
Entity
Organization
Contact information
Practice address
198 RUTLEDGE AVE, SUITE 1, CHARLESTON, SC 29403-5817
(843) 723-0855
(843) 723-1307
Mailing address
198 RUTLEDGE AVE, SUITE 1, CHARLESTON, SC 29403-5817
(843) 723-0855
(843) 723-1307
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3608
—
SC
Enumeration date
05/05/2006
Last updated
07/10/2007
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