Healthcare Provider Details

I. General information

NPI: 1689746299
Provider Name (Legal Business Name): GANESHA B. PERERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 HIGHWAY 17 UNIT 306
MURRELLS INLET SC
29576-5098
US

IV. Provider business mailing address

PO BOX 1524
AUGUSTA GA
30903-1524
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 706-774-7263
  • Fax: 706-774-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number31463
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number060964
License Number StateGA

VII. Legacy identifiers

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

# 1
Identifier029
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerTRICARE
# 2
Identifier067
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerBLUE CHOICE
# 3
IdentifierAA46098552
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerMEDICARE PTAN
# 4
Identifier067
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerBCBS
# 5
IdentifierG60964
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 6
Identifier224310
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerMEDCOST

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: