Advanced Medical Associates of Summerville
Organization Active NPI Chiropractor · Summerville, SC
NPI 1790748150 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1790748150
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 1243 (SC)
- Legal business name
- ADVANCED MEDICAL ASSOCIATES OF SUMMERVILLE
- Practice address
- 1711 N Main St
Summerville, SC 29483-7807 - Phone
- (843) 875-2268
- Fax
- (843) 875-2267
- NPI assigned
- Apr 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Jon Lloyd Etheridge, DC
- Title
- President
- Phone
- (843) 875-2268
Practitioners 4
-
Jessica A Lyons, DPT
-
Joni D Nye, MSPT
-
Patricia Susana Sullivan, MD MPH
National Provider Directory
Locations
1055 N Main St
Ste 8
Summerville, SC 29483
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 1243 | SC | Yes |
| General Practice Physician |
208D00000X | 15987 | SC | |
| Physical Therapist |
225100000X | 5123 | SC |
Addresses
Primary practice location
1711 N Main St
Summerville, SC 29483-7807
Mailing address
1711 N Main St
Summerville, SC 29483-7807
Phone (843) 875-2268
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP4385 | Medicaid | SC | |
| 2015987 | Other | SC | CDS |
| CH1243 | Medicaid | SC |
Other providers in Summerville, SC
- Emily Addicks
- Durga Dhoj Adhikari
- Amy Adler
- Buenaventura III Adriano
- Advanced Dental Center of Summerville, P.a.
- Aesthetica LLC
- Affordable Comprehensive Counseling, LLC
- Agilitas USA, Inc
- Agilitas USA, Inc
- Agilitas USA, Inc.
All providers in Summerville, SC · Chiropractor in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.