| Organization Name: | ADVANTAGE HEALTHCARE OF CHARLESTON LLC |
| NPI Number: | 1790086726 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRIS JAMES GRAY (PRESIDENT) |
| Mailing Address: | 122 S Goose Creek Blvd Suite B Goose Creek |
| State: | SC US |
| Postal Code: | 294453136 |
| Phone Number: | 8435532211 |
| Fax Number: | 8435532210 |
| NPI Enumeration Date: | 11/08/2010 |
| NPI Last Update Date: | 06/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 28866 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |