Individual
CHARLES FOSTER GROSSNICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
650 ELLIS OAK DR, CHARLESTON, SC 29412-3089
(843) 792-3451
Mailing address
169 ASHLEY AVENUE, ROOM 202 MAIN HOSPITAL, CHARLESTON, SC 29425-8905
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
LL89816
SC
Other
Enumeration date
05/26/2023
Last updated
06/22/2023
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