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General NPI Number Information
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NPI Number | 1700134186
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Entity Type | Organization
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Legal Business Name | LOWCOUNTRY NEUROPATHY OF HILTON HEAD, LLC
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 09/30/2012
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Provider Practice Location Address
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Address Line | 55A SHERIDAN PARK CIR
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City | BLUFFTON
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State | SC
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Zip | 29910-6025
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Country | US
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Telephone | 843-817-7404
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Fax | 843-529-0234
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Provider Business Mailing Address
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Address Line | 4222 FLYNN DR
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-6784
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Country | US
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Telephone | 843-817-7404
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Fax | 843-529-0234
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Authorized Official
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Title or Position | PARTNER
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Name | WILLIAM MARK LUCKIE
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Credential | D.C.
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Telephone | 843-817-7404
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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 | 23765
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License Number State | SC
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