Individual
DR. WACHOVIA CHANTA' BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1175 GREY PINE DR, BLYTHEWOOD, SC 29016-7320
(803) 995-5599
Mailing address
5800 BRUNSWICK CT, NEW ORLEANS, LA 70131-5425
(717) 880-3740
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
OT013286
PA
207Q00000X
Family Medicine Physician
51870
SC
207Q00000X
Family Medicine Physician
Primary
COVID19-TMP-211
LA
208D00000X
General Practice Physician
OT013286
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2570986
—
LA
05
—
518700
—
SC
Enumeration date
06/09/2009
Last updated
01/06/2022
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