Gourdin, Theodore G
Gourdin, Theodore G is an individual health care provider with primary practice located at 1962 Charlie Hall Blvd , Charleston SC 29414-5837. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Gastroenterology. Allopathic & Osteopathic Physicians / Gastroenterology is his primary health care specialty. Gourdin, Theodore G can be contacted via phone (843) 722-8000.Contact Information
Primary practice address
1962 Charlie Hall Blvd
Charleston SC 29414-5837
Phone: (843) 722-8000
Fax: (843) 647-6066
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 13033 | South Carolina |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 13033 | South Carolina |
Profile Details
| NPI number | 1821094301 |
|---|---|
| LBN Legal business name | Gourdin, Theodore G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 21st, 2005 |
| Last updated | May 7th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821094301 | NPPES |
| South Carolina | MEDICAID | 130334 |
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