Individual
CHARLES EFFIONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51 NASSAU ST, CHARLESTON, SC 29403-5513
(843) 722-4112
(843) 577-8960
Mailing address
P.O. BOX 31093, CHARLESTON, SC 29417
(843) 573-0499
(843) 388-6292
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19174
SC
207RN0300X
Nephrology Physician
19174
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191740
—
SC
01
—
AA83436494
MEDICARE PIN FETTER HEALTH CARE NETWORK
SC
Enumeration date
05/10/2006
Last updated
07/21/2015
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