Healthcare Provider Details

I. General information

NPI: 1306875950
Provider Name (Legal Business Name): HERITAGE DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MAIN ST SUITE D
HILTON HEAD ISLAND SC
29926-4614
US

IV. Provider business mailing address

PO BOX 3821
BLUFFTON SC
29910-3821
US

V. Phone/Fax

Practice location:
  • Phone: 843-689-5259
  • Fax: 843-689-3797
Mailing address:
  • Phone: 843-689-5259
  • Fax: 843-689-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID SCOTT CARTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 630-590-9250