Provider Demographics
NPI:1326531682
Name:DAVID CHARLES FISHER MD LLC
Entity Type:Organization
Organization Name:DAVID CHARLES FISHER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-995-5555
Mailing Address - Street 1:566 SPEARS CREEK CHURCH RD STE 102B
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8128
Mailing Address - Country:US
Mailing Address - Phone:803-995-5555
Mailing Address - Fax:803-828-3795
Practice Address - Street 1:566 SPEARS CREEK CHURCH RD STE 102B
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8128
Practice Address - Country:US
Practice Address - Phone:803-995-5555
Practice Address - Fax:803-828-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD17710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty