Healthcare Provider Details

I. General information

NPI: 1255483327
Provider Name (Legal Business Name): GEORGETOWN HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 HIGHMARKET ST
GEORGETOWN SC
29440-3121
US

IV. Provider business mailing address

1075 N FRASER ST
GEORGETOWN SC
29440-2848
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-5128
  • Fax: 843-527-7500
Mailing address:
  • Phone: 843-527-4442
  • Fax: 843-527-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WRIGHT
Title or Position: VICE ADMINISTRATOR
Credential:
Phone: 843-527-4442