Individual
JOHN MARK REDWINE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5325 APPIAN WAY, CHARLESTON, SC 29420
(843) 552-0400
(843) 552-1618
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(843) 695-6071
(843) 569-5879
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13521
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060041439
RR MEDICARE
SC
05
—
135213
—
SC
01
—
GP6882
MEDICAID GROUP
SC
Enumeration date
04/27/2006
Last updated
06/10/2021
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