Healthcare Provider Details

I. General information

NPI: 1093977761
Provider Name (Legal Business Name): RADFORD PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 JONES AVENUE
BEAUFORT SC
29902-5325
US

IV. Provider business mailing address

2709 JONES AVENUE
BEAUFORT SC
29902-5325
US

V. Phone/Fax

Practice location:
  • Phone: 843-525-0031
  • Fax: 843-379-1041
Mailing address:
  • Phone: 843-525-0031
  • Fax: 843-379-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberDO964
License Number StateSC

VIII. Authorized Official

Name: DR. ANN ELIZABETH RADFORD
Title or Position: MANAGER
Credential: DO
Phone: 843-379-1041