=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144153834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILTON HEAD REGIONAL PHYSICIAN GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2026
-----------------------------------------------------
Last Update Date | 06/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 MEDICAL CENTER DR STE 240
-----------------------------------------------------
City | HARDEEVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29927-3449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-540-5857
-----------------------------------------------------
Fax | 843-524-5655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 604411
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RCS MANAGER
-----------------------------------------------------
Name | LEEA JEANINE WALTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-316-6081
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------