NPIMap

Kelli S Daughtry

Individual provider Active NPI Physician Assistant · Georgetown, SC

NPI 1154977916 · NPPES record last updated Nov 13, 2025

Key facts

NPI
1154977916
Entity type
Individual (NPI type 1)
Primary specialty
Physician Assistant 363A00000X
License
00010-10521 (NC)
Practice address
1014 Huger Dr
Georgetown, SC 29440-3322
Phone
(843) 520-8780
Fax
(843) 652-8399
NPI assigned
Aug 16, 2019
Sex
Female
Sole proprietor
No

Organizations & group practices 16

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Medicare Care Compare profile

Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Georgetown Physician Associates, LLC (221 clinicians)

Practice addresses (Care Compare)

2200 Crow LN
Myrtle Beach, SC 29577-1663

2347 S Hwy 17
Murrells Inlet, SC 29576-7611
Phone (843) 357-2443

4040 Hwy 17
Murrells Inlet, SC 29576-5098

4070 Hwy 17
Murrells Inlet, SC 29576-5033
Phone (843) 652-1000

Hospital & facility affiliations

  • Tidelands Waccamaw Community Hospital Hospital · Murrells Inlet, SC · CCN 420098

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NC, SC
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20201210002676 NC Practitioner - Physician Assistant 5496167751 Reassigns benefits to 3 organizations
I20250306000320 SC Practitioner - Physician Assistant 5496167751 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5611SCMDOrthopedic Physical Therapist
00010-10521NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Georgetown Physician Associates LLC Current
since Jan 13, 2025		 Accepting new patients
Georgetown Physician Associates LLC Current
since Jan 13, 2025		 Accepting new patients
Goshen Medical Center Incorporated Current
since Nov 9, 2020		 Accepting new patients
Goshen Medical Center Incorporated Current
since Nov 9, 2020		 Accepting new patients
Goshen Medical Center Incorporated Current Accepting new patients
Georgetown Physician Services, LLC Past Accepting new patients
Gardner-Webb University Past
since Aug 1, 2019		 Accepting new patients
Gardner-Webb University Past
since Aug 1, 2019		 Accepting new patients

Locations

444 SW Center St
Faison, NC 28341
Phone (910) 267-0421

110 Eastwood Dr
Wallace, NC 28466
Phone (910) 285-2330

606 Black River Rd
Ste 301
Georgetown, SC 29440
Phone (843) 527-3428

1014 Huger Dr
Georgetown, SC 29440
Phone (843) 652-8390

2347 S Highway 17
Murrells Inlet, SC 29576
Phone (843) 357-2443

4040 Highway 17
Unit 104
Murrells Inlet, SC 29576
Phone (843) 652-8150

4040 Highway 17
Unit 202
Murrells Inlet, SC 29576
Phone (843) 652-8390

2200 Crow Ln
Ste 303B
Myrtle Beach, SC 29577
Phone (843) 520-8780

12117 Ocean Hwy
Pawleys Island, SC 29585
Phone (843) 237-8231

Interoperability endpoints

  • Direct secure messaging: kdaughtry@goshenmedical.cloudcraftdirect.com
  • Direct secure messaging: kdaughtry509731@direct.musc.edu

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 00010-10521 NC Yes

Addresses

Primary practice location

1014 Huger Dr
Georgetown, SC 29440-3322

Mailing address

PO Box 421718
Georgetown, SC 29442-4203
Phone (843) 527-7000

Other practice location 1

2200 Crow Ln Ste 303B
Myrtle Beach, SC 29577-1663
Phone (843) 520-8780

Other practice location 2

4040 Highway 17 Unit 104
Murrells Inlet, SC 29576-5098
Phone (843) 652-8390

Other practice location 3

5115 Oleander Dr
Wilmington, NC 28403-7018
Phone (910) 362-1011

Other practice location 4

4040 Highway 17 Unit 104
Murrells Inlet, SC 29576-5098
Phone (843) 652-8390

Other practice location 5

2200 Crow Ln Ste 303B
Myrtle Beach, SC 29577-1663
Phone (843) 520-8780

Other practice location 6

1014 Huger DR
Georgetown, SC 29440-3322
Phone (843) 520-8780

Other practice location 7

606 Black River Rd Ste 301
Georgetown, SC 29440-3304
Phone (843) 652-8390

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address kdaughtry509731@direct.musc.edu Georgetown Physician Associates, LLC
Direct Messaging Address kdaughtry509731@direct.musc.edu Direct Georgetown Physician Associates, LLC
Direct Messaging Address kdaughtry509731@direct.musc.edu Direct Georgetown Physician Associates, LLC
Direct Messaging Address kdaughtry509731@direct.musc.edu Direct Georgetown Physician Associates, LLC
Direct Messaging Address kdaughtry509731@direct.musc.edu Direct Georgetown Physician Associates, LLC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 13, 2025.

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762992000000",
    "number": "1154977916",
    "addresses": [
        {
            "country_code": "US",
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            "postal_code": "294424203",
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        },
        {
            "country_code": "US",
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            "postal_code": "294403322",
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            "fax_number": "843-652-8399"
        }
    ],
    "practiceLocations": [
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            "country_code": "US",
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        },
        {
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        },
        {
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            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 Crow Ln Ste 303B",
            "address_purpose": "LOCATION",
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            "country_code": "US",
            "telephone_number": "843-520-8780",
            "fax_number": "843-652-8399",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1014 Huger DR",
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            "country_code": "US",
            "telephone_number": "843-520-8780",
            "fax_number": "843-652-8399",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "606 Black River Rd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "SC",
            "postal_code": "294403304",
            "country_code": "US",
            "telephone_number": "843-652-8390",
            "fax_number": "843-652-8399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAUGHTRY",
        "first_name": "KELLI",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-16",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "00010-10521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdaughtry509731@direct.musc.edu",
            "affiliation": "Y",
            "affiliationName": "Georgetown Physician Associates, LLC",
            "address_1": "4040 Highway 17",
            "address_2": "Suite 202",
            "city": "Murrells Inlet",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29576",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
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            "endpoint": "kdaughtry509731@direct.musc.edu",
            "affiliation": "Y",
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            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4040 Highway 17 Unit 104",
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            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdaughtry509731@direct.musc.edu",
            "affiliation": "Y",
            "affiliationName": "Georgetown Physician Associates, LLC",
            "use": "DIRECT",
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            "address_1": "1014 Huger DR",
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            "postal_code": "294403322",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdaughtry509731@direct.musc.edu",
            "affiliation": "Y",
            "affiliationName": "Georgetown Physician Associates, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "606 Black River Rd Ste 301",
            "city": "Georgetown",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294403304",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdaughtry509731@direct.musc.edu",
            "affiliation": "Y",
            "affiliationName": "Georgetown Physician Associates, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2200 Crow Ln Ste 303B",
            "city": "Myrtle Beach",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295771663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Georgetown, SC

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Sources for this page

Verify at the official NPI Registry.