Provider Demographics
NPI:1225037765
Name:STURDIVANT, RACHEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:L
Last Name:STURDIVANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:843-723-7404
Practice Address - Street 1:171 ASHLEY AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0100
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:843-723-7404
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC22000207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC220004Medicaid
SC220004Medicaid