Healthcare Provider Details

I. General information

NPI: 1467402792
Provider Name (Legal Business Name): LOWCOUNTRY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GAMECOCK AVE SUITE D
CHARLESTON SC
29407-3368
US

IV. Provider business mailing address

21 GAMECOCK AVE SUITE D
CHARLESTON SC
29407-3368
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-7906
  • Fax:
Mailing address:
  • Phone: 843-763-7906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: LINDA C SHOEMAKER
Title or Position: COO
Credential:
Phone: 843-937-8101