Basic Information
| Provider Information | |||||||||
| NPI: | 1679568216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUCKS | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | DELL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 989 RIBAUT RD | ||||||||
| Address2: | STE 260 | ||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299025472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435227600 | ||||||||
| FaxNumber: | 8435227612 | ||||||||
| Practice Location | |||||||||
| Address1: | 989 RIBAUT RD | ||||||||
| Address2: | STE 260 | ||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299025472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435227600 | ||||||||
| FaxNumber: | 8435227612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 06/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 18927 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110213340 | 01 | SC | RAILROAD MEDICARE | OTHER | 189272 | 05 | SC | MEDICAID |