1285941609 NPI number — LOW COUNTRY PHYSICIANS GROUP, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285941609 NPI number — LOW COUNTRY PHYSICIANS GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOW COUNTRY PHYSICIANS GROUP, LLC
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:
1285941609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5665 NEW NORTHSIDE DR NW
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-5831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-874-5400
Provider Business Mailing Address Fax Number:
770-874-5483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1304 W BOBO NEWSOM HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTSVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29550-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-339-2100
Provider Business Practice Location Address Fax Number:
770-874-5483
Provider Enumeration Date:
09/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DURHAM
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-874-5400

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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