NPIMap

Organization Active NPI

Georgetown Physician Services, LLC

Doing business as Waccamaw Family Medicine

  • Family Medicine Physician
  • Georgetown, SC
National Provider Identifier
1497062384
Registry record updated Sep 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GEORGETOWN PHYSICIAN SERVICES, LLC
Doing business as
Waccamaw Family Medicine
Practice address
1075 N Fraser St
Georgetown, SC 29440-2848
Phone
(843) 527-4442
Fax
(843) 527-4027
NPI assigned
Sep 13, 2010
Last updated
Sep 13, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2010

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

Authorized official

Name
Ms. Sue Stark
Title
Coadministrator
Phone
(843) 543-0090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X SC Primary

Addresses

Primary practice location

1075 N Fraser St
Georgetown, SC 29440-2848

Mailing address

9699 Ocean Hwy
Pawleys Island, SC 29585-7425
Phone (843) 237-4297

Other names 1

  • Waccamaw Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Waccamaw Family Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1284336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284336000000",
    "number": "1497062384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9699 OCEAN HWY",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "295857425",
            "telephone_number": "843-237-4297",
            "fax_number": "843-237-4095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402848",
            "telephone_number": "843-527-4442",
            "fax_number": "843-527-4027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-13",
        "last_updated": "2010-09-13",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "COADMINISTRATOR",
        "authorized_official_telephone_number": "843-543-0090",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waccamaw Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; 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.