NPIMap

Organization Active NPI

Charleston Pediatrics

  • Pediatrics Physician
  • Charleston, SC
National Provider Identifier
1013965474
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHARLESTON PEDIATRICS
Practice address
198 Rutledge Ave
Suite 1
Charleston, SC 29403-5817
Phone
(843) 723-0855
Fax
(843) 723-1307
NPI assigned
May 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Authorized official

Name
Dr. Thomas Godfrey Quattlebaum, M.D.
Title
President
Phone
(843) 723-0855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X SC Primary

Addresses

Primary practice location

198 Rutledge Ave
Suite 1
Charleston, SC 29403-5817

Mailing address

198 Rutledge Ave
Suite 1
Charleston, SC 29403-5817
Phone (843) 723-0855

Other identifiers 1

IdentifierTypeStateIssuer
GP3608MedicaidSC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0673254Sweetgrass Pediatrics- Downtown Charleston Dba198 Rutledge Avenue Suite 1, Charleston, SC 29403RegistrationOct 22, 2026

National Provider Directory

National Provider Directory

Locations

198 Rutledge Ave
Ste 1
Charleston, SC 29403
Phone (843) 469-1608

1200 Innovation Way
Ste 201
Mt Pleasant, SC 29466
Phone (843) 876-1454

1440 Ben Sawyer Blvd
Ste 1109
Mt Pleasant, SC 29464
Phone (843) 876-8333

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1013965474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "198 RUTLEDGE AVE",
            "address_2": "SUITE 1",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035817",
            "telephone_number": "843-723-0855",
            "fax_number": "843-723-1307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 RUTLEDGE AVE",
            "address_2": "SUITE 1",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035817",
            "telephone_number": "843-723-0855",
            "fax_number": "843-723-1307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "QUATTLEBAUM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "GODFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-723-0855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3608",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.