| Fetter Health Care Network-downtown Site | |
|
51 Nassau St Charleston SC 29403 | |
| (843) 722-4112 | |
| (843) 577-8960 |
| Full Name | Fetter Health Care Network-downtown Site |
|---|---|
| Speciality | Clinic/Center |
| Location | 51 Nassau St, Charleston, South Carolina |
| Authorized Official Name and Position | Aretha R Jones (CEO) |
| Authorized Official Contact | 8437224112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fetter Health Care Network-downtown Site 51 Nassau St Charleston SC 29403-5513 Ph: (843) 722-4112 | Fetter Health Care Network-downtown Site 51 Nassau St Charleston SC 29403 Ph: (843) 722-4112 |
| NPI Number | 1003827304 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 11/21/2023 |
| Medicare PECOS PAC ID | 9032215199 |
|---|---|
| Medicare Enrollment ID | O20070507000192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003827304 | NPI | - | NPPES |
| FQC004 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Charles Effiong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487604757 PECOS PAC ID: 1658358668 Enrollment ID: I20040708000013 |
| Provider Name | Rose Delores Gibbs |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548299159 PECOS PAC ID: 7911974803 Enrollment ID: I20040915000066 |
| Provider Name | Larry L Wilson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1356345094 PECOS PAC ID: 4587562434 Enrollment ID: I20041213000331 |
| Provider Name | Whitney W Thoma |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1770547895 PECOS PAC ID: 0244279743 Enrollment ID: I20050425000977 |
| Provider Name | Olumide M Mughelli |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1154378214 PECOS PAC ID: 9537101696 Enrollment ID: I20050601000082 |
| Provider Name | Allahna A Coggins |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1861454977 PECOS PAC ID: 2365472602 Enrollment ID: I20050817000157 |
| Provider Name | Dana L Simpson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124019328 PECOS PAC ID: 9234169467 Enrollment ID: I20050817000890 |
| Provider Name | Joyce A Noriega |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1881677326 PECOS PAC ID: 6507884517 Enrollment ID: I20051108000995 |
| Provider Name | Jessica D Townsend |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003861881 PECOS PAC ID: 7810908282 Enrollment ID: I20060523000051 |
| Provider Name | Joanne Price Williamson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1407058944 PECOS PAC ID: 9739272881 Enrollment ID: I20070905000405 |
| Provider Name | Keith Alexander Taylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447320189 PECOS PAC ID: 5698740595 Enrollment ID: I20071205000031 |
| Provider Name | Alberto B Santos |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134237175 PECOS PAC ID: 1456420165 Enrollment ID: I20080521000550 |
| Provider Name | Lynn M Manfred |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346230661 PECOS PAC ID: 0345282232 Enrollment ID: I20080723000001 |
| Provider Name | Terri O Fowler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720242225 PECOS PAC ID: 1557436748 Enrollment ID: I20080822000445 |
| Provider Name | Elizabeth May Leonard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508906256 PECOS PAC ID: 3678629201 Enrollment ID: I20101116000741 |
| Provider Name | Andrea Sarah Mendelsohn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053514695 PECOS PAC ID: 4082801717 Enrollment ID: I20101207001367 |
| Provider Name | Joann Lynn Csakany |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1851300420 PECOS PAC ID: 0749463776 Enrollment ID: I20110329000149 |
| Provider Name | Richette Deas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295061117 PECOS PAC ID: 5193900439 Enrollment ID: I20110429000548 |
| Provider Name | Tingting Huang |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1306071170 PECOS PAC ID: 2668629197 Enrollment ID: I20120905000743 |
| Provider Name | Eleanor R Jenkins-alford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689743569 PECOS PAC ID: 8628221181 Enrollment ID: I20130111000149 |
| Provider Name | Joye Elizabeth Fordham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497073407 PECOS PAC ID: 6608095252 Enrollment ID: I20140915001281 |
| Provider Name | Melissa Dawn Bowers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023242625 PECOS PAC ID: 4587980867 Enrollment ID: I20150304000445 |
| Provider Name | Anisha S Hezekiah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689094997 PECOS PAC ID: 0547588600 Enrollment ID: I20150421002347 |
| Provider Name | Jessica Elaine Marzolf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467852657 PECOS PAC ID: 4880913979 Enrollment ID: I20150512002733 |
| Provider Name | Pamela Sherl Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861503799 PECOS PAC ID: 2668640715 Enrollment ID: I20150707000815 |
| Provider Name | Katherine Claire Proffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225420466 PECOS PAC ID: 7416267620 Enrollment ID: I20151029002944 |
| Provider Name | Sharon E Bullard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841301793 PECOS PAC ID: 1355519331 Enrollment ID: I20151215001428 |
| Provider Name | Whitney A Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457689077 PECOS PAC ID: 7810293206 Enrollment ID: I20160310001940 |
| Provider Name | Taisha C'mone Roberts |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679884803 PECOS PAC ID: 6103123278 Enrollment ID: I20160405001180 |
| Provider Name | Sharvette L Slaughter |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033210505 PECOS PAC ID: 3173816915 Enrollment ID: I20160801001606 |
| Provider Name | Lindsay D Foley |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1245591403 PECOS PAC ID: 4183913817 Enrollment ID: I20160802002421 |
| Provider Name | Dana J Laforte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306299557 PECOS PAC ID: 7911295910 Enrollment ID: I20161006001288 |
| Provider Name | Cielita K Halyard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154872919 PECOS PAC ID: 8527348002 Enrollment ID: I20161130000491 |
| Provider Name | Callie C Meeks |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1932464377 PECOS PAC ID: 4587947940 Enrollment ID: I20170208002258 |
| Provider Name | Tina M Howard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922453059 PECOS PAC ID: 6204119886 Enrollment ID: I20170518002861 |
| Provider Name | Carol D Jackson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1649496910 PECOS PAC ID: 6305102286 Enrollment ID: I20171109000125 |
| Provider Name | Ramonica H Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316458599 PECOS PAC ID: 4981964111 Enrollment ID: I20180208002253 |
| Provider Name | Patricia D Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437558228 PECOS PAC ID: 8224390190 Enrollment ID: I20180313002144 |
| Provider Name | Caitlin Briggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679088942 PECOS PAC ID: 1355603093 Enrollment ID: I20180319000010 |
| Provider Name | Robert Jason Heineck |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013113893 PECOS PAC ID: 3375799257 Enrollment ID: I20180724002428 |
| Provider Name | Gregory L Glover |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1295814390 PECOS PAC ID: 6002996048 Enrollment ID: I20180820000429 |
| Provider Name | Kelly Nicole Morales |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306132881 PECOS PAC ID: 3971750563 Enrollment ID: I20181015003448 |
| Provider Name | Jennifer Freeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386115848 PECOS PAC ID: 5698013175 Enrollment ID: I20190207001181 |
| Provider Name | Kay E Berland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194935650 PECOS PAC ID: 9739322322 Enrollment ID: I20190222000448 |
| Provider Name | Mary Elizabeth Creed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942775366 PECOS PAC ID: 9830439678 Enrollment ID: I20190314000864 |
| Provider Name | Charles T Tweel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003993528 PECOS PAC ID: 6608951934 Enrollment ID: I20190802001482 |
| Provider Name | Russell D Swanger |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1114913514 PECOS PAC ID: 8921195694 Enrollment ID: I20191023002263 |
| Provider Name | Kareemah M Stepney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376990218 PECOS PAC ID: 1658703715 Enrollment ID: I20191112002167 |
| Provider Name | Mckenzie E Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528566932 PECOS PAC ID: 9234561754 Enrollment ID: I20191120003385 |
| Provider Name | Glenda Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124579040 PECOS PAC ID: 0143654061 Enrollment ID: I20200102000356 |
| Provider Name | Laura Caitlin Minehart |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1952574113 PECOS PAC ID: 2668782988 Enrollment ID: I20200114002911 |
| Provider Name | Edward Odell Reece |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1275593188 PECOS PAC ID: 4880593029 Enrollment ID: I20200331000105 |
| Provider Name | Teri Galter |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1851778435 PECOS PAC ID: 6103804687 Enrollment ID: I20200924001042 |
| Provider Name | Meghan Hodapp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477150340 PECOS PAC ID: 1951713031 Enrollment ID: I20201214002670 |
| Provider Name | Asia T Mcdonald |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194880203 PECOS PAC ID: 8729118450 Enrollment ID: I20210730001613 |
| Provider Name | Helen C Ballestas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144511601 PECOS PAC ID: 1557504792 Enrollment ID: I20211120000002 |
| Provider Name | Alexandra Potts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104569979 PECOS PAC ID: 0042677577 Enrollment ID: I20230526002602 |
| Provider Name | Pooja A. Paunikar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801150297 PECOS PAC ID: 5890003594 Enrollment ID: I20230724004083 |
| Provider Name | Kimberly R Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154085074 PECOS PAC ID: 9234589078 Enrollment ID: I20231220001814 |
| Provider Name | Lakeya Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164055174 PECOS PAC ID: 5890147755 Enrollment ID: I20240117000977 |
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