Provider Demographics
NPI:1972584712
Name:BICKERSTAFF, CHARLES A JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:BICKERSTAFF
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:452 FOLLY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2641
Mailing Address - Country:US
Mailing Address - Phone:843-762-9321
Mailing Address - Fax:843-406-9777
Practice Address - Street 1:102 WAPPOO CREEK DR STE 10C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-762-9321
Practice Address - Fax:843-406-9777
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2018-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC8659207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3774Medicaid
SCGP3774Medicaid