Individual
DR. FREDRICK J. ASTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, APRN, PMHCNS-BC
Contact information
Practice address
2638 TWO NOTCH ROAD, SUITE 110, COLUMBIA, SC 29204
(803) 256-2500
(803) 758-1726
Mailing address
PO BOX 5731, COLLEGE OF NURSING, COLUMBIA, SC 29250-5731
(803) 256-2500
(803) 758-1726
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4291
SC
163WP0808X
Psychiatric/Mental Health Registered Nurse
R38298
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA72856580
MEDICARE PTAN
SC
Enumeration date
08/28/2007
Last updated
09/15/2011
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