# GEORGETOWN PEDIATRIC CENTER, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760682637
- **Authorized official:** PAUL J HLETKO MD (PRESIDENT)
- **Authorized official phone:** (843) 546-8686

## Contact information

- **Practice address:** 57 JESSAMINE AVE, GEORGETOWN, SC 29440-5837
- **Practice address phone:** (843) 546-8686
- **Practice address fax:** (843) 546-1353
- **Mailing address:** PO BOX 618, GEORGETOWN, SC 29442-0618
- **Mailing address phone:** (843) 546-8686
- **Mailing address fax:** (843) 546-1356

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 14532 | SC | Yes |

## Other

- **Enumeration date:** 07/19/2007
- **Last updated:** 03/18/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP0557 | — | SC |
| 05 | — | RHC031 | — | SC |