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Organization

TIDEWATER INTERNAL MEDICINE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LAURA LEE KINNEY M.D. (MANAGING PARTNER)
(843) 571-6868
Entity
Organization

Contact information

Practice address
2097 HENRY TECKLENBURG DR, SUITE 220, CHARLESTON, SC 29414-5740
(843) 571-6868
(843) 571-6198
Mailing address
2097 HENRY TECKLENBURG DR, SUITE 220, CHARLESTON, SC 29414-5740
(843) 571-6868
(843) 571-6198

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
19466
SC

Other

Enumeration date
06/27/2006
Last updated
10/04/2007
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