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NPI Code Detail

MEDICARE: LIBERTY DOCTORS LLC

MEDICARE: LIBERTY DOCTORS 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
1208000000XPediatrics Physician

Other Identifiers

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

General Provider Information

NPI Number : 1558928614
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY DOCTORS LLC
Provider Business Mailing Address
First Line : PO BOX 13955
Second Line :
City : CHARLESTON
State : SC
Zip : 29422-3955
Country : US
Telephone Number : 843-225-8320
Fax Number : 843-225-3549
Provider Business Practice Location Address
First Line : 8761 DORCHESTER RD STE 100
Second Line :
City : CHARLESTON
State : SC
Zip : 29420-7320
Country : US
Telephone Number : 843-747-4647
Fax Number : 843-745-0969
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : CHELSEY DEVER
Credential :
Telephone Number : 843-225-8320
Provider Enumeration Date : 05/23/2019
Last Update Date : 03/26/2026

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Directions to “LIBERTY DOCTORS LLC ” Practice Location

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