Organization
ADVANCED MEDICAL ASSOCIATES OF SUMMERVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON LLOYD ETHERIDGE DC (PRESIDENT)
(843) 875-2268
Entity
Organization
Contact information
Practice address
1711 N MAIN ST, SUMMERVILLE, SC 29483-7807
(843) 875-2268
(843) 875-2267
Mailing address
1711 N MAIN ST, SUMMERVILLE, SC 29483-7807
(843) 875-2268
(843) 875-2267
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1243
SC
208D00000X
General Practice Physician
15987
SC
225100000X
Physical Therapist
5123
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015987
CDS
SC
05
—
CH1243
—
SC
05
—
GP4385
—
SC
Enumeration date
04/07/2006
Last updated
03/07/2023
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