MEDICARE: PPCP SPECIALTY PHYSICIANS , 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	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063914992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PPCP SPECIALTY PHYSICIANS , LLC

Provider Business Mailing Address
First Line	:	PO BOX 530062
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-0062
Country	:	US
Telephone Number	:	843-695-6071
Fax Number	:	843-569-5879

Provider Business Practice Location Address
First Line	:	899 ISLAND PARK DR STE 200
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-8114
Country	:	US
Telephone Number	:	843-856-6402
Fax Number	:	843-216-5068

Authorized Official
Title or Position	:	CEO
Name	:	TERRY CUNNINGHAM
Credential	:
Telephone Number	:	843-695-6071

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	02/28/2022

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