# EAST COOPER PHYSICIAN GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** High Tide Internal Medicine - East Cooper Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255192308
- **Authorized official:** DOREATHA ROGERS (RCS MANAGER)
- **Authorized official phone:** (980) 302-7992

## Contact information

- **Practice address:** 880 ISLAND PARK DR UNIT 220, DANIEL ISLAND, SC 29492-2902
- **Practice address phone:** (843) 380-9330
- **Practice address fax:** (843) 380-8212
- **Mailing address:** PO BOX 604408, CHARLOTTE, NC 28260-4408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/17/2024
- **Last updated:** 02/28/2026