Provider Type Icon

LIBERTY DOCTORS LLC NPI 1689129652


NPI Information

NPI: 1689129652
Provider Name: LIBERTY DOCTORS, LLC

Doing Business As: DR. DENNIS FISHER

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 42D2156913

Address:
21 GAMECOCK AVE
CHARLESTON, SC
ZIP 29407
Phone: (843) 763-9664
Get Directions

LIBERTY DOCTORS, LLC is a family medicine in Charleston, SC. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. LIBERTY DOCTORS, LLC NPI is 1689129652. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Dr. Dennis Fisher.

The provider's business location address is:

21 GAMECOCK AVE
CHARLESTON, SC
ZIP 29407-368
Phone: (843) 763-9664
Fax: (843) 763-2949

The provider's authorized official is Sara Elizabeth Maynor-hardy .
The authorized official title is Credinetialing Coordinator and has the following contact phone number (843) 225-8320.

The CLIA number assigned to this NPI record is 42D2156913 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/19/2016 and was last updated on 8/24/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineSOUTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GP6738MEDICAIDSOUTH CAROLINA
2A634MEDICARE UPINSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.