Provider Demographics
NPI:1881973923
Name:KIDNEY DISEASE CONSULTANTS, LLC
Entity type:Organization
Organization Name:KIDNEY DISEASE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:EFFIONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-697-4132
Mailing Address - Street 1:PO BOX 31093
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-1093
Mailing Address - Country:US
Mailing Address - Phone:843-697-4132
Mailing Address - Fax:843-566-0401
Practice Address - Street 1:1370 REMOUNT RD
Practice Address - Street 2:STE D
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3322
Practice Address - Country:US
Practice Address - Phone:843-697-4132
Practice Address - Fax:843-566-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19174207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty