Individual
JEFFREY RUSSELL PIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5070 INTERNATIONAL BLVD STE 131, N CHARLESTON, SC 29418-6007
(843) 402-5053
(843) 724-1325
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1385
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0744PA
—
SC
01
—
AA86079223
MEDICARE PIN
SC
Enumeration date
10/07/2008
Last updated
01/19/2022
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