Provider Demographics
NPI:1356050561
Name:CHARLESTON GASTROENTEROLOGY SPECIALISTS
Entity type:Organization
Organization Name:CHARLESTON GASTROENTEROLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-793-5188
Mailing Address - Street 1:2001 2ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7887
Mailing Address - Country:US
Mailing Address - Phone:843-793-5182
Mailing Address - Fax:843-266-5125
Practice Address - Street 1:328 MIDLAND PKWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8102
Practice Address - Country:US
Practice Address - Phone:843-722-8000
Practice Address - Fax:843-647-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0680Medicaid