Organization
LOWCOUNTRY UROLOGY CLINICS, PA
Active
Parent organization
LOWCOUNTRY UROLOGY CLINICS, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
LOWCOUNTRY UROLOGY CLINICS, PA
Authorized official
DIANE S HADER (DELEGATED OFFICIAL)
(843) 284-4267
Entity
Organization
Contact information
Practice address
125 DOUGHTY ST, SUITE 770, CHARLESTON, SC 29403-5736
(843) 577-6015
(843) 727-2972
Mailing address
2687 LAKE PARK DR, N CHARLESTON, SC 29406-9100
(843) 725-4414
(843) 725-3118
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4434
—
SC
Enumeration date
08/05/2008
Last updated
04/16/2009
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