NPIMap

Organization Active NPI

Family Wellness Center of Charleston

  • Family Medicine Physician
  • North Charleston, SC
National Provider Identifier
1013396027
Registry record updated May 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
LIC-1-15-126877 Issued in SC
Legal business name
FAMILY WELLNESS CENTER OF CHARLESTON
Practice address
9217 University Blvd
Suite C1B
North Charleston, SC 29406-9147
Phone
(843) 729-8269
NPI assigned
May 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stania Dejesus
Title
Owner
Phone
(843) 729-8269

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X LIC-1-15-126877 SC Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MDO.1175DO SC

Addresses

Primary practice location

9217 University Blvd
Suite C1B
North Charleston, SC 29406-9147

Mailing address

9217 University Blvd
Suite C1B
North Charleston, SC 29406-9147
Phone (843) 729-8269

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432252800000",
    "number": "1013396027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9217 UNIVERSITY BLVD",
            "address_2": "SUITE C1B",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069147",
            "telephone_number": "843-729-8269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9217 UNIVERSITY BLVD",
            "address_2": "SUITE C1B",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069147",
            "telephone_number": "843-729-8269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY WELLNESS CENTER OF CHARLESTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-22",
        "last_updated": "2015-05-22",
        "status": "A",
        "authorized_official_last_name": "DEJESUS",
        "authorized_official_first_name": "STANIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-729-8269"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "LIC-1-15-126877",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "MDO.1175DO",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.