Waccamaw Gastroenterology, PC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

WACCAMAW GASTROENTEROLOGY, PC

Practice address

1011 N Fraser St
Georgetown, SC 29440-2848

Phone

(843) 527-3428

Fax

(843) 546-8216

NPI assigned

May 19, 2006

Last updated

Feb 5, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Laurence Havens Ballou, MDNPI 1962487306

Title

Partner

Phone

(843) 527-3428

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Laurence Havens Ballou Jr., MD

  • Gastroenterology Physician
  • Georgetown, SC
  • NPI 1962487306
  Authorized official Same address or phone

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1548213564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402848",
            "telephone_number": "843-527-3428",
            "fax_number": "843-546-8216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402848",
            "telephone_number": "843-527-3428",
            "fax_number": "843-546-8216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACCAMAW GASTROENTEROLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "BALLOU",
        "authorized_official_first_name": "LAURENCE",
        "authorized_official_middle_name": "HAVENS",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "843-527-3428",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1579",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Georgetown, SC
• Providers in Georgetown, SC by specialty
• Gastroenterology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; 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.