Organization
VALCOURT PEDIATRIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA MAREE HART (PRACTICE ADMINSTRATOR)
(843) 782-3636
Entity
Organization
Contact information
Practice address
124 MEDICAL PARK DR, WALTERBORO, SC 29488-5719
(843) 782-3636
(843) 782-3269
Mailing address
124 MEDICAL PARK DR, WALTERBORO, SC 29488-5719
(843) 782-3636
(843) 782-3269
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
29352
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G58526
—
SC
Enumeration date
11/22/2011
Last updated
11/22/2011
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