Organization
TIDEWATER SURGICAL GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORRAINE VERONICA TYLER (PRACTICE ADMINISTRAOT)
(843) 797-8880
Entity
Organization
Contact information
Practice address
2831B TRICOM ST, NORTH CHARLESTON, SC 29406-9172
(843) 797-8880
(843) 797-8884
Mailing address
2831B TRICOM ST, NORTH CHARLESTON, SC 29406-9172
(843) 797-8880
(843) 797-8884
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G93021
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4370
—
SC
Enumeration date
11/08/2006
Last updated
08/22/2020
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