Organization
EXECUTIVE COURT MEDICAL SPECIALIST P.C.
Active
Other names
AKA E C Medical Specialist
Organization subpart
No
Provider details
NPI number
Authorized official
JANET FAYE BUCHANAN (OFFICE MANAGER)
(843) 839-4505
Entity
Organization
Contact information
Practice address
997 HWY 17 BUSINESS SOUTH, SUITE C, SURFSIDE BEACH, SC 29575-6084
(843) 839-4505
(843) 839-2851
Mailing address
4701 OLEANDER DRIVE, SUITE B, MYRTLE BEACH, SC 29577
(843) 497-6301
(843) 497-6506
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
15450
SC
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
15451
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558345686
NPI
SC
05
—
GP0772
—
SC
Enumeration date
05/10/2007
Last updated
11/26/2008
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