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Organization
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Active
Organization
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Active
Other names
Tidelands Health Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH WARD (EVP & CFO)
(843) 527-7102
Entity
Organization
Contact information
Practice address
11916 HIGHWAY 707 STE D, MURRELLS INLET, SC 29576-9610
(843) 652-8220
(843) 652-8032
Mailing address
PO BOX 421718, GEORGETOWN, SC 29442-4203
(843) 520-8883
(843) 652-8422
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PENDING
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C120
FAMILY MEDICINE
SC
05
—
GP8121
—
SC
05
—
GP8841
—
SC
Enumeration date
09/21/2017
Last updated
06/15/2020
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