MEDICARE: GYNECOLOGY ASSOCIATES OF BEAUFORT PC

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1952657223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GYNECOLOGY ASSOCIATES OF BEAUFORT PC

Provider Business Mailing Address
First Line	:	109 S HERMITAGE RD
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902-5713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 N PARIS AVE
Second Line	:	SUITE 108
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-2029
Country	:	US
Telephone Number	:	843-812-0483
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICIA THOMPSON
Credential	:	MD
Telephone Number	:	843-812-0483

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/26/2012

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