Healthcare Provider Details

I. General information

NPI: 1841739968
Provider Name (Legal Business Name): PPCP SPECIALTY PHYSICIANS , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 OLD TROLLEY RD STE 300
SUMMERVILLE SC
29485-5293
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-376-2670
  • Fax: 843-376-2790
Mailing address:
  • Phone: 843-695-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number31768
License Number StateSC

VIII. Authorized Official

Name: TERRY CUNNINGHAM
Title or Position: CEO
Credential:
Phone: 843-572-7727