Healthcare Provider Details

I. General information

NPI: 1023122728
Provider Name (Legal Business Name): INLET PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BANDAGE COURT
MURRELLS INLET SC
29576
US

IV. Provider business mailing address

PO BOX 4920
MURRELLS INLET SC
29576-2699
US

V. Phone/Fax

Practice location:
  • Phone: 843-652-3300
  • Fax:
Mailing address:
  • Phone: 843-652-3300
  • Fax: 843-652-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierGP4436
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: DR. AMANDA GUYTON DROSIEKO
Title or Position: PHYSICIAN
Credential: MD
Phone: 843-652-3300