Healthcare Provider Details

I. General information

NPI: 1205607967
Provider Name (Legal Business Name): HILTON HEAD REGIONAL PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BAYLOR DR STE 155
BLUFFTON SC
29910-8965
US

IV. Provider business mailing address

PO BOX 37643
BELFAST ME
04915-1218
US

V. Phone/Fax

Practice location:
  • Phone: 843-682-7480
  • Fax: 843-681-9169
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DOREATHA ROGERS
Title or Position: RCS MANAGER
Credential:
Phone: 980-302-7992