Healthcare Provider Details

I. General information

NPI: 1467413641
Provider Name (Legal Business Name): BEAUFORT PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 RIBAUT RD
BEAUFORT SC
29902-5429
US

IV. Provider business mailing address

964 RIBAUT RD
BEAUFORT SC
29902-5429
US

V. Phone/Fax

Practice location:
  • Phone: 843-524-5437
  • Fax: 843-524-0425
Mailing address:
  • Phone: 843-524-5437
  • Fax: 843-524-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH H FLOYD
Title or Position: PREISDENT
Credential: M.D.
Phone: 843-524-5437