United States Air Force

NPI #1023246659 in Charleston Afb, South Carolina

Provider Information

NPI Number: 1023246659
Entity Type: Organization
Organization Name: United States Air Force
Primary Specialty: Clinic/Center
Enumeration Date: Jun 22, 2009
Last Updated: Jun 22, 2009

Practice Location

Address: 204 W HILL BLVD
City: Charleston Afb
State: South Carolina
ZIP Code: 29404-4704
Phone: (843) 963-6936

Authorized Official

Name: MR. RONNIE LEE GODBOLT
Title: INDEPENDENT DUTY MEDICAL TECHNICIAN
Phone: (843) 963-6936

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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