Healthcare Provider Details

I. General information

NPI: 1336050541
Provider Name (Legal Business Name): STEPHANIE CAMARGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 WILLIAM HILTON PKWY STE 7
HILTON HEAD ISLAND SC
29928-2703
US

IV. Provider business mailing address

111 CHELSEA LN
RIDGELAND SC
29936-5659
US

V. Phone/Fax

Practice location:
  • Phone: 843-715-4060
  • Fax: 843-715-4060
Mailing address:
  • Phone: 843-422-0574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number7059
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: