Provider Demographics
NPI:1881189843
Name:JOSEY, DRENNAN
Entity Type:Individual
Prefix:
First Name:DRENNAN
Middle Name:
Last Name:JOSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 HARBOR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4352
Mailing Address - Country:US
Mailing Address - Phone:843-356-9673
Mailing Address - Fax:843-852-9404
Practice Address - Street 1:2097 HENRY TECKLENBURG DR STE 210
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5739
Practice Address - Country:US
Practice Address - Phone:843-356-9673
Practice Address - Fax:843-852-9404
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1479213ES0103X
SCPOD722213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD7227Medicaid