Healthcare Provider Details

I. General information

NPI: 1134296700
Provider Name (Legal Business Name): GEORGETOWN INTERNISTS AND PEDIATRICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BUSINESS CENTER DR
PAWLEYS ISLAND SC
29585-7963
US

IV. Provider business mailing address

64 BUSINESS CENTER DR
PAWLEYS ISLAND SC
29585-7963
US

V. Phone/Fax

Practice location:
  • Phone: 843-314-1314
  • Fax: 843-314-1308
Mailing address:
  • Phone: 843-314-1314
  • Fax: 843-314-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208000000X
License Number StateSC

VII. Legacy identifiers

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

# 1
IdentifierGP3598
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MRS. LYNNE A READ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 843-314-1305