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General NPI Number Information
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NPI Number | 1720140825
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Entity Type | Organization
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Legal Business Name | BEAUFORT PEDIATRICS, P.A.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 964 RIBAUT RD
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City | BEAUFORT
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State | SC
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Zip | 29902-5429
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Country | US
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Telephone | 843-524-5437
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Fax | 843-524-0425
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Provider Business Mailing Address
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Address Line | 964 RIBAUT RD
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City | BEAUFORT
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State | SC
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Zip | 29902-5429
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Country | US
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Telephone | 843-524-5437
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Fax | 843-524-0425
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM D MARTIN III
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Credential | MD
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Telephone | 843-524-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 12254
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License Number State | SC
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