Organization
TIDEWATER DOCTORS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA HURLEY (PRACTICE ADMINISTRATOR)
(843) 200-7721
Entity
Organization
Contact information
Practice address
2270 ASHLEY CROSSING DR STE 150, CHARLESTON, SC 29414-5702
(843) 766-1936
(843) 766-1206
Mailing address
2834 AQUADUCT ST, CHARLESTON, SC 29414-7410
(843) 200-7721
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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