Basic Information
| Provider Information | |||||||||
| NPI: | 1649548132 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WACCAMAW ONCOLOGY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2405 N FRASER ST | ||||||||
| Address2: | PO BOX 1539 | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294407764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435457274 | ||||||||
| FaxNumber: | 8435458315 | ||||||||
| Practice Location | |||||||||
| Address1: | 2405 N FRASER ST | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294407764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435457274 | ||||||||
| FaxNumber: | 8435458315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2011 | ||||||||
| LastUpdateDate: | 12/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | DEANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8435273428 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.