1912177239 NPI number — SOUTH CAROLINA CANCER SPECIALIST, P.A.

Table of content: (NPI 1912177239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912177239 NPI number — SOUTH CAROLINA CANCER SPECIALIST, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CAROLINA CANCER SPECIALIST, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912177239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 E 65TH ST STE 22
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405-4493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-819-2146
Provider Business Mailing Address Fax Number:
912-819-3320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 HOSPITAL CENTER CMNS STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILTON HEAD ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29926-2837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-689-2895
Provider Business Practice Location Address Fax Number:
843-689-9270
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
YVETTA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
NETWORK CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
912-819-2146

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP3117 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA3698 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP9576 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4225377 . This is a "NCPDP" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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