Healthcare Provider Details

I. General information

NPI: 1679523989
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

349 FOLLY RD SUITE B
CHARLESTON SC
29412-2508
US

IV. Provider business mailing address

349 FOLLY RD SUITE B
CHARLESTON SC
29412-2508
US

V. Phone/Fax

Practice location:
  • Phone: 843-762-2323
  • Fax:
Mailing address:
  • Phone: 843-762-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateSC
# 3
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