Provider Demographics
NPI:1437588423
Name:MOUNT PLEASANT NEPHROLOGY LLC
Entity Type:Organization
Organization Name:MOUNT PLEASANT NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-637-0525
Mailing Address - Street 1:900 BOWMAN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3203
Mailing Address - Country:US
Mailing Address - Phone:843-637-0525
Mailing Address - Fax:
Practice Address - Street 1:900 BOWMAN RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3203
Practice Address - Country:US
Practice Address - Phone:843-637-0525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23565207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty