Healthcare Provider Details

I. General information

NPI: 1902918147
Provider Name (Legal Business Name): GEORGE D GRICE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 ALBEMARLE RD
CHARLESTON SC
29407-7540
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-6426
  • Fax: 843-722-2193
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number14445
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: