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General NPI Number Information
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NPI Number | 1366776544
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Entity Type | Organization
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Legal Business Name | GEORGETOWN INTERNAL MEDICINE, LLC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 1016 HUGER DR
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City | GEORGETOWN
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State | SC
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Zip | 29440-3322
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Country | US
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Telephone | 843-546-6158
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Fax | 843-546-0660
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Provider Business Mailing Address
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Address Line | 1016 HUGER DR
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City | GEORGETOWN
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State | SC
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Zip | 29440-3322
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Country | US
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Telephone | 843-546-6158
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Fax | 843-546-0660
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Authorized Official
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Title or Position | MANAGER
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Name | MARCIA BATCHELOR
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Credential |
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Telephone | 843-520-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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