Healthcare Provider Details

I. General information

NPI: 1912118464
Provider Name (Legal Business Name): HHMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MAIN ST
HILTON HEAD SC
29926-1676
US

IV. Provider business mailing address

3801 MAIN ST
HILTON HEAD SC
29926
US

V. Phone/Fax

Practice location:
  • Phone: 843-342-4463
  • Fax:
Mailing address:
  • Phone: 843-342-4463
  • Fax: 843-342-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3996
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021580
License Number StateSC

VIII. Authorized Official

Name: MRS. ANNE PITTMAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 843-342-4463