Healthcare Provider Details

I. General information

NPI: 1902237357
Provider Name (Legal Business Name): EAST COOPER PRIMARY CARE PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 STATION 22 1/2 ST
SULLIVANS ISLAND SC
29482-9756
US

IV. Provider business mailing address

PO BOX 742828
ATLANTA GA
30374-2828
US

V. Phone/Fax

Practice location:
  • Phone: 843-883-3176
  • Fax: 843-883-3459
Mailing address:
  • Phone: 843-883-3176
  • Fax: 843-883-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY O. JAMES
Title or Position: REGIONAL CFO, TENET
Credential:
Phone: 404-265-5009