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Individual

JORDAN LANE FOUTCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-1405
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
66051
TN
208000000X
Pediatrics Physician
Primary
84704
SC
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
66051
TN

Other

Enumeration date
04/24/2017
Last updated
11/04/2025
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