Organization
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Active
Other names
Tidelands Health Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SUTHERLAND WARD (EVP & CFO)
(843) 527-7102
Entity
Organization
Contact information
Practice address
9699 OCEAN HWY, PAWLEYS ISLAND, SC 29585
(843) 237-4297
(843) 237-0495
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
—
SC
261QP2300X
Primary Care Clinic/Center
—
SC
261QR1300X
Rural Health Clinic/Center
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP6554
—
SC
05
—
RHC202
—
SC
Enumeration date
11/27/2007
Last updated
06/25/2020
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