# GEORGETOWN PHYSICIAN ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tidelands Health Pediatrics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053967943
- **Authorized official:** ELIZABETH SUTHERLAND WARD (EVP & CFO)
- **Authorized official phone:** (843) 527-7102

## Contact information

- **Practice address:** 4320 HOLMESTOWN RD STE B, MYRTLE BEACH, SC 29588-7837
- **Practice address phone:** (843) 652-8440
- **Practice address fax:** (843) 652-8441
- **Mailing address:** PO BOX 421718, GEORGETOWN, SC 29442-4203
- **Mailing address phone:** (843) 652-8440

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/15/2019
- **Last updated:** 05/01/2020