Organization
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Active
Other names
Tidelands Health Oncology
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SUTHERLAND WARD (EVP & CFO)
(843) 527-7102
Entity
Organization
Contact information
Practice address
2405 N FRASER ST, GEORGETOWN, SC 29440
(843) 545-7274
(843) 545-8315
Mailing address
PO BOX 421718, GEORGETOWN, SC 29442-4203
(843) 520-8883
(843) 652-8422
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP6530
—
SC
05
—
GP7345
—
SC
Enumeration date
06/19/2014
Last updated
06/25/2020
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