Provider Demographics
NPI:1326048828
Name:EMMEL, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:EMMEL
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 1:27 GAMECOCK AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3398
Mailing Address - Country:US
Mailing Address - Phone:843-769-8215
Mailing Address - Fax:843-769-8216
Practice Address - Street 1:27 GAMECOCK AVE
Practice Address - Street 2:STE 201
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3398
Practice Address - Country:US
Practice Address - Phone:843-769-8215
Practice Address - Fax:843-769-8216
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8833207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8833Medicaid
SCD176037041Medicare PIN
SC8833Medicaid