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Organization
LIBERTY DOCTORS LLC DBA EBB TIDE COMPREHENSIVE CARE
Active
Organization
LIBERTY DOCTORS LLC DBA EBB TIDE COMPREHENSIVE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHELSEY DEVER (CREDENTIALING COORDINATOR)
(843) 225-8320
Entity
Organization
Contact information
Practice address
669 MARINA DR STE A2, CHARLESTON, SC 29492-7573
(843) 491-9955
Mailing address
669 MARINA DR STE A, CHARLESTON, SC 29492-7542
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
246XC2903X
Vascular Specialist/Technologist Cardiovascular
—
NULL
246XC2903X
Vascular Specialist/Technologist Cardiovascular
—
—
Other
Enumeration date
01/04/2024
Last updated
12/19/2025
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