Healthcare Provider Details

I. General information

NPI: 1508849837
Provider Name (Legal Business Name): GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N FRASER ST
GEORGETOWN SC
29440-2848
US

IV. Provider business mailing address

PO BOX 421718
GEORGETOWN SC
29442-4203
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-5128
  • Fax: 843-527-4027
Mailing address:
  • Phone: 843-520-8330
  • Fax: 843-652-8422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WARD
Title or Position: EVP & CFO
Credential:
Phone: 843-527-7102