Individual
KATELYN CODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-3235
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4655
SC
363AS0400X
Surgical Physician Assistant
25MP00501500
NJ
Other
Enumeration date
11/07/2018
Last updated
07/09/2024
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