Healthcare Provider Details

I. General information

NPI: 1982630125
Provider Name (Legal Business Name): HERITAGE DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 LADYS ISLAND DR
BEAUFORT SC
29907-1728
US

IV. Provider business mailing address

3901 MAIN ST STE D
HILTON HEAD ISLAND SC
29926-4613
US

V. Phone/Fax

Practice location:
  • Phone: 843-525-9277
  • Fax: 843-525-9150
Mailing address:
  • Phone: 843-689-5259
  • Fax: 843-689-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID SCOTT CARTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 630-590-9250