Healthcare Provider Details

I. General information

NPI: 1215985072
Provider Name (Legal Business Name): ELIZABETH A SNODERLY DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CHURCH ST
GEORGETOWN SC
29440-2403
US

IV. Provider business mailing address

PO BOX 2429
MURRELLS INLET SC
29576-2429
US

V. Phone/Fax

Practice location:
  • Phone: 843-545-5927
  • Fax:
Mailing address:
  • Phone: 843-651-2624
  • Fax: 843-357-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH A SNODERLY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 843-545-5927