# HOPECLINIC WALTERBORO

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

## Provider details

- **NPI number:** 1912967290
- **Authorized official:** TEMISAN L ETIKERENTSE MD (CEO MD)
- **Authorized official phone:** (843) 549-9200

## Contact information

- **Practice address:** 211 EDDIE CHASTEEN DR, WALTERBORO, SC 29488-5728
- **Practice address phone:** (843) 549-9200
- **Practice address fax:** (843) 549-8476
- **Mailing address:** 211 EDDIE CHASTEEN DR, WALTERBORO, SC 29488-5728
- **Mailing address phone:** (843) 549-9200
- **Mailing address fax:** (843) 549-8476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 20234 | SC | Yes |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP3914 | — | SC |