NPIMap

Organization Active NPI

Charles B. Maxwell, DMD, PA

  • Clinic/Center
  • Johnsonville, SC
National Provider Identifier
1851345557
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
2117 Issued in SC
Legal business name
CHARLES B. MAXWELL, DMD, PA
Practice address
144 East Broadway St.
Johnsonville, SC 29555-0297
Phone
(843) 386-2833
Fax
(843) 386-2279
NPI assigned
May 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Charles B Maxwell, DMDNPI 1215138516
Title
Owner
Phone
(843) 386-2833

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 2117 SC Primary

Addresses

Primary practice location

144 East Broadway St.
Johnsonville, SC 29555-0297

Mailing address

144 East Broadway St.
PO Box 297
Johnsonville, SC 29555-0297
Phone (843) 386-2833

Other identifiers 1

IdentifierTypeStateIssuer
Z2117-4MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851345557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 EAST BROADWAY ST.",
            "address_2": "PO BOX 297",
            "city": "JOHNSONVILLE",
            "state": "SC",
            "postal_code": "295550297",
            "telephone_number": "843-386-2833",
            "fax_number": "843-386-2279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 EAST BROADWAY ST.",
            "city": "JOHNSONVILLE",
            "state": "SC",
            "postal_code": "295550297",
            "telephone_number": "843-386-2833",
            "fax_number": "843-386-2279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES B. MAXWELL, DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-386-2833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "SC",
            "license": "2117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z2117-4",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnsonville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.