Healthcare Provider Details

I. General information

NPI: 1033169156
Provider Name (Legal Business Name): LOWCOUNTRY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 SAVAGE RD
CHARLESTON SC
29407-4726
US

IV. Provider business mailing address

1871 SAVAGE RD
CHARLESTON SC
29407-4726
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-6308
  • Fax:
Mailing address:
  • Phone: 843-766-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateSC

VIII. Authorized Official

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