Healthcare Provider Details

I. General information

NPI: 1093585044
Provider Name (Legal Business Name): PPCP SPECIALTY PHYSICIANS , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9313 MEDICAL PLAZA DR STE 202
CHARLESTON SC
29406-9176
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-1200
  • Fax:
Mailing address:
  • Phone: 843-572-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOLINDA L PHILLIPS
Title or Position: SR ANALYST OF REVENUE CYCLE
Credential:
Phone: 843-572-7727