Healthcare Provider Details

I. General information

NPI: 1124673793
Provider Name (Legal Business Name): GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 CROW LN STE 201
MYRTLE BEACH SC
29577-1663
US

IV. Provider business mailing address

PO BOX 421718
GEORGETOWN SC
29442-4203
US

V. Phone/Fax

Practice location:
  • Phone: 843-848-5220
  • Fax: 843-848-5225
Mailing address:
  • Phone: 843-848-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ELIZABETH SUTHERLAND WARD
Title or Position: EVP & CFO
Credential:
Phone: 843-527-7102