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General NPI Number Information
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NPI Number | 1821158122
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Entity Type | Organization
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Legal Business Name | SC278 MEDICAL GROUP PA
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Dates
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Enumeration Date | 12/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1714 TICKTON HALL RD
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City | RIDGELAND
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State | SC
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Zip | 29936-7719
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Country | US
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Telephone | 843-726-2194
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Fax | 843-726-9423
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Provider Business Mailing Address
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Address Line | PO BOX 3066
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City | BLUFFTON
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State | SC
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Zip | 29910-3066
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Country | US
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Telephone | 843-757-5966
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Fax | 843-757-5996
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT DOUGLAS CONDIE
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Credential | MD
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Telephone | 843-757-5966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 15103
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License Number State | SC
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