# TIDEWATER DOCTORS LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1821769290
- **Authorized official:** ANDREA HURLEY (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (843) 200-7721

## Contact information

- **Practice address:** 2270 ASHLEY CROSSING DR STE 155, CHARLESTON, SC 29414-5749
- **Practice address phone:** (843) 990-5866
- **Practice address fax:** (843) 868-8041
- **Mailing address:** 2834 AQUADUCT ST, CHARLESTON, SC 29414-7410
- **Mailing address phone:** (843) 200-7721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/24/2021
- **Last updated:** 09/24/2021