Individual
DR. MATTHEW JUSTICE KORNEGAY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1483 TOBIAS GADSON BLVD STE 101, CHARLESTON, SC 29407-4795
(843) 405-1110
(855) 654-2149
Mailing address
1483 TOBIAS GADSON BLVD STE 101, CHARLESTON, SC 29407-4795
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
31144
SC
208000000X
Pediatrics Physician
Primary
31144
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
311442
—
SC
01
—
P00834834
RAILROAD MEDICARE ID-RSFPN
SC
Enumeration date
06/15/2006
Last updated
09/19/2023
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