Healthcare Provider Details

I. General information

NPI: 1053445817
Provider Name (Legal Business Name): SEACOAST PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 DANIEL ELLIS DR SUITE 2 A
CHARLESTON SC
29412-3094
US

IV. Provider business mailing address

776 DANIEL ELLIS DR SUITE 2 A
CHARLESTON SC
29412-3094
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-8100
  • Fax: 843-722-3010
Mailing address:
  • Phone: 843-795-8100
  • Fax: 843-722-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number19333
License Number StateSC

VIII. Authorized Official

Name: DR. MEGHAN ODOM GEILS
Title or Position: SECRETARY
Credential: MD
Phone: 843-795-8100