Healthcare Provider Details

I. General information

NPI: 1174335491
Provider Name (Legal Business Name): EAST COOPER PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 S ALLIANCE DR STE 111B
GOOSE CREEK SC
29445-7296
US

IV. Provider business mailing address

PO BOX 37642
BELFAST ME
04915-1218
US

V. Phone/Fax

Practice location:
  • Phone: 843-971-9350
  • Fax: 843-971-9351
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL KIRKLAND
Title or Position: ENROLLMENT COORDINATOR
Credential:
Phone: 469-893-2695