Healthcare Provider Details

I. General information

NPI: 1457301624
Provider Name (Legal Business Name): LOWCOUNTRY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WINGO WAY SUITE 207
MT PLEASANT SC
29464
US

IV. Provider business mailing address

180 WINGO WAY SUITE 207
MT PLEASANT SC
29464
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-5101
  • Fax:
Mailing address:
  • Phone: 843-884-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: LINDA C SHOEMAKER
Title or Position: COO
Credential:
Phone: 843-937-8101