NPIMap

Organization Active NPI

Liberty Doctors LLC

  • Family Medicine Physician
  • Charleston, SC
National Provider Identifier
1659831246
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIBERTY DOCTORS LLC
Practice address
1315 Ashley River Rd
Charleston, SC 29407-5315
Phone
(854) 429-1175
NPI assigned
Mar 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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 1

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

Addresses

Primary practice location

1315 Ashley River Rd
Charleston, SC 29407-5315

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
GP6738MedicaidSC
A634OtherSCMEDICARE PTAN

Other names 1

  • Simple Medicine Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2156913Liberty Doctors Dba Simple Medicine1315 Ashley River Unit 1, Charleston, SC 29407Certificate of waiverOct 25, 2026

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.

Locations

1315 Ashley River Rd
#1
Charleston, SC 29407

NPI Registry JSON

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765756800000",
    "number": "1659831246",
    "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": "1315 ASHLEY RIVER RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294075315",
            "telephone_number": "854-429-1175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY DOCTORS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-21",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6738",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "A634",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Simple Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Simple Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.