Organization
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Active
Other names
Tidelands Health Breast Center
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SUTHERLAND WARD (EVP & CFO)
(843) 527-7102
Entity
Organization
Contact information
Practice address
4181 HIGHWAY 17, MURRELLS INLET, SC 29576
(843) 651-3308
Mailing address
PO BOX 421718, GEORGETOWN, SC 29442-4203
(843) 520-8883
(843) 652-8422
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP6476
—
SC
Enumeration date
02/05/2014
Last updated
06/15/2020
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