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NPI Code Detail

MEDICARE: GEORGETOWN HEALTH GROUP

MEDICARE: GEORGETOWN HEALTH GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144401365
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGETOWN HEALTH GROUP
Provider Business Mailing Address
First Line : 1075 N FRASER ST
Second Line :
City : GEORGETOWN
State : SC
Zip : 29440-2848
Country : US
Telephone Number : 843-527-4442
Fax Number : 843-527-4027
Provider Business Practice Location Address
First Line : 701 S MORGAN AVE
Second Line :
City : ANDREWS
State : SC
Zip : 29510-2959
Country : US
Telephone Number : 843-264-5253
Fax Number :
Authorized Official
Title or Position : CO-ADMINISTRATOR
Name : SUE R. STARK
Credential :
Telephone Number : 843-527-4442
Provider Enumeration Date : 11/15/2007
Last Update Date : 11/19/2007

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Directions to “GEORGETOWN HEALTH GROUP ” Practice Location

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