# GEORGETOWN PHYSICIAN ASSOCIATES, LLC

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

## Provider details

- **NPI number:** 1114780483
- **Authorized official:** ELIZABETH SUTHERLAND WARD (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (843) 527-7102

## Contact information

- **Practice address:** 4040 HIGHWAY 17 UNIT 205, MURRELLS INLET, SC 29576-5098
- **Practice address phone:** (843) 652-8475
- **Practice address fax:** (843) 652-8476
- **Mailing address:** PO BOX 421718, GEORGETOWN, SC 29442-4203

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/31/2024
- **Last updated:** 03/25/2024