Provider Demographics
NPI:1235108721
Name:CHARLESTON INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:CHARLESTON INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANON
Authorized Official - Middle Name:WELCH
Authorized Official - Last Name:HONNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-406-4948
Mailing Address - Street 1:537 FOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3007
Mailing Address - Country:US
Mailing Address - Phone:843-406-4948
Mailing Address - Fax:843-406-4940
Practice Address - Street 1:537 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3007
Practice Address - Country:US
Practice Address - Phone:843-406-4948
Practice Address - Fax:843-406-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22489261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH90229Medicare UPIN
SC7694Medicare ID - Type UnspecifiedPROVIDER ID NUMBER