Organization
GEORGETOWN PHYSICIAN SERVICES, LLC
Active
Other names
Waccamaw Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
SUE R. STARK (CO-ADMINISTRATOR)
(843) 527-4442
Entity
Organization
Contact information
Practice address
9699 OCEAN HWY, PAWLEYS ISLAND, SC 29585-7425
(843) 237-4296
(843) 237-0495
Mailing address
1075 N FRASER ST, GEORGETOWN, SC 29440-2848
(843) 527-4442
(843) 527-0495
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1370
—
SC
05
—
GP4819
—
SC
Enumeration date
10/22/2007
Last updated
11/03/2010
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