Healthcare Provider Details

I. General information

NPI: 1285633289
Provider Name (Legal Business Name): SOUTH CAROLINA CANCER SPECIALIST, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HOSPITAL CENTER CMNS STE 200
HILTON HEAD ISLAND SC
29926-2837
US

IV. Provider business mailing address

836 E 65TH ST STE 22
SAVANNAH GA
31405-4493
US

V. Phone/Fax

Practice location:
  • Phone: 843-689-2895
  • Fax: 843-689-9270
Mailing address:
  • Phone: 912-819-2146
  • Fax: 912-819-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number14194
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YVETTA P LEE
Title or Position: NETWORK CREDENTIALING COORDINATOR
Credential:
Phone: 912-819-2146