Provider Demographics
NPI:1578626552
Name:CHARLESTON WOMENS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:CHARLESTON WOMENS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-767-2121
Mailing Address - Street 1:5319 PARKSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-2102
Mailing Address - Country:US
Mailing Address - Phone:843-767-2121
Mailing Address - Fax:843-767-2102
Practice Address - Street 1:5319 PARKSHIRE WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-2102
Practice Address - Country:US
Practice Address - Phone:843-767-2121
Practice Address - Fax:843-767-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20332207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT45742Medicaid
SCGP2837OtherGROUP MEDICAID NUMBER
SC14069596843OtherMRDICARE ID
SCGP2837OtherGROUP MEDICAID NUMBER
6843Medicare PIN