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General NPI Number Information
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NPI Number | 1619283306
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Entity Type | Organization
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Legal Business Name | GEORGETOWN GASTROENTEROLOGY, LLC
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 1011 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 | 843-527-3428
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Fax | 843-546-8216
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Provider Business Mailing Address
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Address Line | PO BOX 1209
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City | MURRELLS INLET
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State | SC
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Zip | 29576-1209
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Country | US
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Telephone | 843-652-8220
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Fax | 843-527-7080
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | KENTON HUNGERPILLER
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Credential |
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Telephone | 843-652-8221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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