Provider Demographics
NPI:1124201702
Name:ANNETTE BILTON ANDERSON, MD
Entity type:Organization
Organization Name:ANNETTE BILTON ANDERSON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:BILTON
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-795-5362
Mailing Address - Street 1:418 FOLLY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2625
Mailing Address - Country:US
Mailing Address - Phone:843-795-5362
Mailing Address - Fax:843-266-5133
Practice Address - Street 1:418 FOLLY RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2625
Practice Address - Country:US
Practice Address - Phone:843-795-5362
Practice Address - Fax:843-266-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC070568Medicaid
G950018848Medicare PIN
SCG95001Medicare UPIN