Individual
JUSTIN THOMAS MCGONIGAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-6966
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-1414
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5306
SC
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
12/13/2021
Last updated
05/09/2024
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