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NPI Code Detail

MEDICARE: LIBERTY DOCTORS, LLC

MEDICARE: LIBERTY DOCTORS, 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
1207Q00000XFamily Medicine PhysicianSC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821443896
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY DOCTORS, LLC
Provider Business Mailing Address
First Line : PO BOX 13955
Second Line :
City : CHARLESTON
State : SC
Zip : 29422-3955
Country : US
Telephone Number : 843-225-8304
Fax Number : 843-225-3549
Provider Business Practice Location Address
First Line : 9133 TIMBER ST
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9075
Country : US
Telephone Number : 843-797-6444
Fax Number : 843-779-6438
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : CHELSEY DEVER
Credential :
Telephone Number : 843-225-8320
Provider Enumeration Date : 04/27/2016
Last Update Date : 12/15/2025

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Directions to “LIBERTY DOCTORS, LLC ” Practice Location

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