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General NPI Number Information
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NPI Number | 1194380162
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Entity Type | Organization
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Legal Business Name | LIBERTY DOCTORS, LLC
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 2270 ASHLEY CROSSING DR STE 165
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City | CHARLESTON
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State | SC
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Zip | 29414-5865
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Country | US
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Telephone | 843-936-4455
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Fax | 843-268-2670
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Provider Business Mailing Address
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Address Line | PO BOX 13955
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City | CHARLESTON
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State | SC
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Zip | 29422-3955
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Country | US
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Telephone | 843-225-8320
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Fax | 843-225-3549
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CHELSEY DEVER
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Credential |
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Telephone | 843-225-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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