Healthcare Provider Details

I. General information

NPI: 1578110672
Provider Name (Legal Business Name): ALICIA J FOXWORTH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 WILLBROOK BLVD UNIT A
PAWLEYS ISLAND SC
29585-8410
US

IV. Provider business mailing address

779 HARRELSON RD
GEORGETOWN SC
29440-4808
US

V. Phone/Fax

Practice location:
  • Phone: 800-809-1265
  • Fax:
Mailing address:
  • Phone: 800-809-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25881
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: