Individual
DR. JOHN WILLIAM MCGILLICUDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0100
(843) 792-3368
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
27803
SC
208600000X
Surgery Physician
4301072012
MI
Other
Enumeration date
04/16/2007
Last updated
10/22/2020
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