MEDICARE: HILTON HEAD REGIONAL PHYSICIAN GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1023889763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILTON HEAD REGIONAL PHYSICIAN GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 604411
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-4411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 OKATIE CENTER BLVD S STE 100
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-7519
Country	:	US
Telephone Number	:	843-705-9145
Fax Number	:	843-705-7024

Authorized Official
Title or Position	:	RCS MANAGER
Name	:	LEEA JEANINE WALTON
Credential	:
Telephone Number	:	704-316-6081

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	02/28/2026

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