Provider Demographics
NPI:1598657223
Name:GOVAN, SANQUAN
Entity type:Individual
Prefix:
First Name:SANQUAN
Middle Name:
Last Name:GOVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9116 MAPLE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8789
Mailing Address - Country:US
Mailing Address - Phone:843-509-2807
Mailing Address - Fax:
Practice Address - Street 1:9116 MAPLE GROVE DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8789
Practice Address - Country:US
Practice Address - Phone:843-509-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty