NPIMap

Organization Active NPI

Georgetown Physician Services, LLC

  • Family Medicine Physician
  • Pawleys Island, SC
National Provider Identifier
1962691402
Registry record updated Nov 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GEORGETOWN PHYSICIAN SERVICES, LLC
Practice address
9699 Ocean Hwy
Pawleys Island, SC 29585-7425
Phone
(843) 237-4296
Fax
(843) 237-0495
NPI assigned
Oct 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2010

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

Authorized official

Name
Sue R. Stark
Title
Co-Administrator
Phone
(843) 527-4442

Specialties & licenses 1

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

Addresses

Primary practice location

9699 Ocean Hwy
Pawleys Island, SC 29585-7425

Mailing address

1075 N Fraser St
Georgetown, SC 29440-2848
Phone (843) 527-4442

Other identifiers 2

IdentifierTypeStateIssuer
GP1370MedicaidSC
GP4819MedicaidSC

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.

Locations

606 Black River Rd
Ste 3003
Georgetown, SC 29440

606 Black River Rd
Ste 300
Georgetown, SC 29440
Phone (843) 527-4343

4367 Riverwood Dr
Unit 140
Murrells Inlet, SC 29576
Phone (843) 357-3162

4040 Highway 17
Ste AND105
Murrells Inlet, SC 29576

4040 Highway 17
Unit 104
Murrells Inlet, SC 29576
Phone (843) 652-8150

4017 Highway 17
Ste 100
Murrells Inlet, SC 29576
Phone (843) 651-6525

4367 Riverwood Dr
Unit 100
Murrells Inlet, SC 29576
Phone (843) 527-7139

2200 Crow Ln
Ste 303A
Myrtle Beach, SC 29577
Phone (843) 848-5310

2200 Crow Ln
Ste 303B
Myrtle Beach, SC 29577
Phone (843) 520-8780

2200 Crow Ln
Ste 303C
Myrtle Beach, SC 29577
Phone (843) 652-8475

Practitioners & affiliated clinicians

Practitioners 214

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 214

NPI Registry JSON

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288742400000",
    "number": "1962691402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402848",
            "telephone_number": "843-527-4442",
            "fax_number": "843-527-0495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9699 OCEAN HWY",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "295857425",
            "telephone_number": "843-237-4296",
            "fax_number": "843-237-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2010-11-03",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "SUE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CO-ADMINISTRATOR",
        "authorized_official_telephone_number": "843-527-4442"
    },
    "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": "GP1370",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4819",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waccamaw Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pawleys Island, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.