Organization
ADVANTAGE HEALTHCARE OF CHARLESTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRIS JAMES GRAY (PRESIDENT)
(843) 553-2211
Entity
Organization
Contact information
Practice address
122 S GOOSE CREEK BLVD, SUITE B, GOOSE CREEK, SC 29445-3136
(843) 553-2211
(843) 553-2210
Mailing address
122 S. GOOSE CREEK BLVD, STE B, GOOSE CREEK, SC 29445-0488
(843) 553-2211
(843) 553-2210
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
28866
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA66739888
MEDICARE PTAN
SC
Enumeration date
11/08/2010
Last updated
01/24/2020
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