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General NPI Number Information
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NPI Number | 1760083562
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Entity Type | Organization
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Legal Business Name | LIBERTY DOCTORS LLC
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 9133 TIMBER ST
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9075
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Country | US
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Telephone | 843-779-6444
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Fax | 843-779-6438
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Provider Business Mailing Address
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Address Line | 9133 TIMBER ST
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9075
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Country | US
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Telephone | 843-779-6444
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Fax | 843-779-6438
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. SARA ELIZABETH MAYNOR-HARDY
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Credential |
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Telephone | 843-225-8320
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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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