NPIMap

Organization Active NPI

Liberty Doctors, LLC

  • Internal Medicine Physician
  • Edisto Island, SC
National Provider Identifier
1033844253
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LIBERTY DOCTORS, LLC
Practice address
134 Jungle Rd
Edisto Island, SC 29438-3005
Phone
(843) 897-7757
Fax
(843) 897-7877
NPI assigned
Jul 21, 2022
Organization subpart
Yes
Parent organization
LIBERTY DOCTORS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chelsey Dever
Title
Credentialing Coordinator
Phone
(843) 225-8320

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

134 Jungle Rd
Edisto Island, SC 29438-3005

Mailing address

PO Box 13955
Charleston, SC 29422-3955
Phone (843) 225-8320

Other names 1

  • Internal Medicine Of Edisto Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Liberty Doctors LLC Dba Ebb Tide Comprehensive Care12 organizations share this tax ID, including this one
Part of
Liberty Doctors LLC Dba Ebb Tide Comprehensive Care

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1033844253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13955",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294223955",
            "telephone_number": "843-225-8320",
            "fax_number": "843-225-3549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 JUNGLE RD",
            "city": "EDISTO ISLAND",
            "state": "SC",
            "postal_code": "294383005",
            "telephone_number": "843-897-7757",
            "fax_number": "843-897-7877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY DOCTORS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIBERTY DOCTORS, LLC",
        "enumeration_date": "2022-07-21",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "DEVER",
        "authorized_official_first_name": "CHELSEY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "843-225-8320"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Internal Medicine Of Edisto",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Internal Medicine Of Edisto",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edisto Island, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.