MEDICARE: GEORGETOWN PHYSICIAN ASSOCIATES, LLC

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
1	207Q00000X	Family Medicine Physician	PENDING	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C120	OTHER	SC	FAMILY MEDICINE

General Provider Information

NPI Number	:	1720597743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGETOWN PHYSICIAN ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 421718
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29442-4203
Country	:	US
Telephone Number	:	843-520-8883
Fax Number	:	843-652-8422

Provider Business Practice Location Address
First Line	:	11916 HIGHWAY 707 STE D
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-9610
Country	:	US
Telephone Number	:	843-652-8220
Fax Number	:	843-652-8032

Authorized Official
Title or Position	:	EVP & CFO
Name	:	ELIZABETH WARD
Credential	:
Telephone Number	:	843-527-7102

Provider Enumeration Date	:	09/21/2017
Last Update Date	:	06/15/2020

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