Provider Demographics
NPI:1629029178
Name:MCKINNEY, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:MCKINNEY
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 1:74 HOSPITALITY ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2696
Mailing Address - Country:US
Mailing Address - Phone:843-607-4496
Mailing Address - Fax:843-556-1599
Practice Address - Street 1:815 SAVANNAH HWY
Practice Address - Street 2:OCAN SUN COUNSELING CENTER
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7349
Practice Address - Country:US
Practice Address - Phone:843-556-4541
Practice Address - Fax:843-556-1599
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC168231Medicaid