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General NPI Number Information
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NPI Number | 1407852304
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Entity Type | Individual
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Provider Name | CHAD R. HUBERTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 945 82ND PKWY
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-4610
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Country | US
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Telephone | 843-497-5929
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Fax | 843-839-6375
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Provider Business Mailing Address
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Address Line | PO BOX 3439
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-0439
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Country | US
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Telephone | 843-839-4447
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 26640
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License Number State | SC
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