Provider Demographics
NPI:1821155888
Name:OVANNA BUDHRAM, JONI SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JONI
Middle Name:SUE
Last Name:OVANNA BUDHRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:701 MEDICAL PARK DR
Mailing Address - Street 2:STE 108
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4777
Mailing Address - Country:US
Mailing Address - Phone:843-332-6645
Mailing Address - Fax:843-332-9894
Practice Address - Street 1:701 MEDICAL PARK DR
Practice Address - Street 2:SUITE 108
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4777
Practice Address - Country:US
Practice Address - Phone:843-332-6645
Practice Address - Fax:843-332-9229
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC28451208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC28451OtherSC LICENSE NUMBER