| United States Air Force | |
| 
					204 W Hill Blvd Charleston Afb SC 29404-4704  | |
| (843) 963-6936 | |
| (843) 963-6903 | 
| Full Name | United States Air Force | 
|---|---|
| Speciality | Clinic/center | 
| Location | 204 W Hill Blvd, Charleston Afb, South Carolina | 
| Authorized Official Name and Position | Ronnie Lee Godbolt (INDEPENDENT DUTY MEDICAL TECHNICIAN) | 
| Authorized Official Contact | 8439636936 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| United States Air Force 204 W Hill Blvd Charleston Afb SC 29404-4704 Ph: (843) 963-6936  | United States Air Force 204 W Hill Blvd Charleston Afb SC 29404-4704 Ph: (843) 963-6936  | 
| NPI Number | 1023246659 | 
|---|---|
| Provider Enumeration Date | 06/22/2009 | 
| Last Update Date | 06/22/2009 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1023246659 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |