Provider Demographics
NPI:1801898432
Name:NIVENS, CHARLES JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:NIVENS
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 1:19 ROSE HILL DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4720
Mailing Address - Country:US
Mailing Address - Phone:843-705-7471
Mailing Address - Fax:843-705-7475
Practice Address - Street 1:3 PLANTATION PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-705-7471
Practice Address - Fax:843-705-7475
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18439208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC184393Medicaid
SC184393Medicaid
SCG29922-0281Medicare ID - Type Unspecified