Provider Demographics
NPI:1255495644
Name:INMAN, JOHN GARDNER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GARDNER
Last Name:INMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 CALHOUN ST
Mailing Address - Street 2:STUDENT HEALTH SERVICES COLLEGE OF CHARLESTON
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29424-3519
Mailing Address - Country:US
Mailing Address - Phone:843-953-5520
Mailing Address - Fax:
Practice Address - Street 1:880 ISLAND PARK DR UNIT 200
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-2902
Practice Address - Country:US
Practice Address - Phone:843-856-1771
Practice Address - Fax:843-856-8788
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGO1940Medicare UPIN