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General NPI Number Information
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NPI Number | 1255483327
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Entity Type | Organization
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Legal Business Name | GEORGETOWN HEALTH GROUP
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 1530 HIGHMARKET ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-3121
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Country | US
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Telephone | 843-546-5128
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Fax | 843-527-7500
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Provider Business Mailing Address
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Address Line | 1075 N FRASER ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-2848
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Country | US
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Telephone | 843-527-4442
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Fax | 843-527-4027
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Authorized Official
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Title or Position | VICE ADMINISTRATOR
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Name | AMANDA WRIGHT
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Credential |
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Telephone | 843-527-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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