Georgetown Physician Associates, LLC
Organization Active NPI Family Medicine Physician · Pawleys Island, SC
NPI 1811233562 · NPPES record last updated Jun 25, 2020
Key facts
- NPI
- 1811233562
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- GEORGETOWN PHYSICIAN ASSOCIATES, LLC
- Practice address
- 12117 Ocean Hwy
Pawleys Island, SC 29585 - Phone
- (843) 237-8231
- Fax
- (843) 237-8551
- NPI assigned
- Dec 28, 2012
- Organization subpart
- No
Authorized official
- Name
- Elizabeth Sutherland Ward
- Title
- Evp & Cfo
- Phone
- (843) 527-7102
Other NPIs on the same Medicare enrollment 30
Practitioners 4
-
Olga Mallett Chrisman, D.O.
-
Jesse T Lewis, M.D.
-
William J Greer, MD
-
Chrysoula Pappa, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130225000067 | SC | Part B Supplier - Clinic/Group Practice | 2365697398 |
Receives reassigned benefits from 302 practitioners 30 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Murrells Inlet, SC; Myrtle Beach, SC; Pawleys Island, SC; Andrews, SC; Georgetown, SC; Hemingway, SC |
National Provider Directory
Locations
1014 Huger Dr
Georgetown, SC 29440
Phone (843) 652-8390
1075 N Fraser St
Ste 100
Georgetown, SC 29440
4033 Highway 17
Ste 107
Murrells Inlet, SC 29576
Phone (843) 527-7000
4070 Highway 17
Ste 101
Murrells Inlet, SC 29576
4070 Highway 17
Ste 107
Murrells Inlet, SC 29576
4040 Highway 17
Unit 205
Murrells Inlet, SC 29576
Phone (843) 652-8120
4017 Highway 17
Murrells Inlt, SC 29576
Phone (843) 651-6525
3515 Caduceus Dr
Ste D
Myrtle Beach, SC 29588
Phone (843) 651-5689
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | |||
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
12117 Ocean Hwy
Pawleys Island, SC 29585
Mailing address
PO Box 421718
Georgetown, SC 29442-4203
Phone (843) 520-8883
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP6125 | Medicaid | SC |
Other names
- Tidelands Health Family Medicine
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | credentialing@tidelandshealth.org | Direct |
Other providers in Pawleys Island, SC
- Genesis Rehabilitation Services
- Georgetown Internists and Pediatricians Inc
- Georgetown Physician Associates, LLC
- Georgetown Physician Associates, LLC
- Georgetown Physician Associates, LLC
- Georgetown Physician Services, LLC
- Georgetown Podiatry Group PC
- Gerber-Millan Womens Care LLC
- Christine S Gerber
- Brittany Wynn Gibson
All providers in Pawleys Island, SC · Family Medicine Physician 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 Jun 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.