Basic Information
Provider Information | |||||||||
NPI: | 1528022423 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GHENT | ||||||||
FirstName: | WILLIAM | ||||||||
MiddleName: | SHAWN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GHENT | ||||||||
OtherFirstName: | SHAWN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 6069 | ||||||||
Address2: |   | ||||||||
City: | WEST COLUMBIA | ||||||||
State: | SC | ||||||||
PostalCode: | 291716069 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8039368900 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2728 SUNSET BLVD | ||||||||
Address2: |   | ||||||||
City: | WEST COLUMBIA | ||||||||
State: | SC | ||||||||
PostalCode: | 291694840 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8032560464 | ||||||||
FaxNumber: | 8039358667 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2006 | ||||||||
LastUpdateDate: | 10/27/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/27/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 14529 | SC | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | 145293 | 05 | SC |   | MEDICAID |