Healthcare Provider Details

I. General information

NPI: 1154437291
Provider Name (Legal Business Name): LOWCOUNTRY GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOSPITAL DR SUITE 300
MOUNT PLEASANT SC
29464-3217
US

IV. Provider business mailing address

1300 HOSPITAL DR SUITE 300
MOUNT PLEASANT SC
29464-3217
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-5200
  • Fax: 843-884-6417
Mailing address:
  • Phone: 843-884-5200
  • Fax: 843-884-6417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL L YANTIS III
Title or Position: PRESIDENT
Credential: MD
Phone: 843-884-5200