Healthcare Provider Details

I. General information

NPI: 1942791090
Provider Name (Legal Business Name): FAMILY MEDICINE OF SAYEBROOK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LANSFORD PL STE 100
MYRTLE BEACH SC
29588-6979
US

IV. Provider business mailing address

106 LANSFORD PL STE 100
MYRTLE BEACH SC
29588-6979
US

V. Phone/Fax

Practice location:
  • Phone: 843-293-8850
  • Fax:
Mailing address:
  • Phone: 843-293-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA GAROZZO
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-293-8850