Organization
MPPG, INC.
Active
Other names
Memorial Health Bluffton
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
14 OKATIE CENTER BLVD. SOUTH, SUITE 101, OKATIE, SC 29909
(843) 836-3800
(843) 705-3828
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(843) 836-3800
(843) 705-3828
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300031676A
—
GA
01
—
CJ4583
RR MEDICARE GROUP
SC
05
—
GP4223
—
SC
Enumeration date
12/08/2006
Last updated
06/01/2011
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