Organization
EAST COOPER PHYSICIAN GROUP LLC
Active
Other names
High Tide Internal Medicine - East Cooper Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DOREATHA ROGERS (RCS MANAGER)
(980) 302-7992
Entity
Organization
Contact information
Practice address
880 ISLAND PARK DR UNIT 220, DANIEL ISLAND, SC 29492-2902
(843) 380-9330
(843) 380-8212
Mailing address
PO BOX 604408, CHARLOTTE, NC 28260-4408
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
01/17/2024
Last updated
02/28/2026
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