Healthcare Provider Details

I. General information

NPI: 1710543236
Provider Name (Legal Business Name): TIMOTHY JAMES HOFFMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BLACK RIVER RD
GEORGETOWN SC
29440-3304
US

IV. Provider business mailing address

606 BLACK RIVER RD
GEORGETOWN SC
29440-3304
US

V. Phone/Fax

Practice location:
  • Phone: 843-520-8405
  • Fax:
Mailing address:
  • Phone: 843-520-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT019016
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: