Basic Information
| Provider Information | |||||||||
| NPI: | 1477163988 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEORGETOWN PHYSICIAN ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 421718 | ||||||||
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| City: | GEORGETOWN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294424203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436528226 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 CROW LN STE 301 | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295771663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438485340 | ||||||||
| FaxNumber: | 8438485345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2020 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | SUTHERLAND | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 8435277102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.