TIDEWATER INTERNAL MEDICINE LLC NPI 1770510695

NPI Information

TIDEWATER INTERNAL MEDICINE, LLC is a primary care clinic center in Charleston, SC. TIDEWATER INTERNAL MEDICINE, LLC NPI is 1770510695. The provider is registered as an organization entity type.

The provider's business location address is:

2097 HENRY TECKLENBURG DR
SUITE 220
CHARLESTON, SC
ZIP 29414-740
Phone: (843) 571-6868
Fax: (843) 571-6198

The provider's authorized official is Laura Lee Kinney .
The authorized official title is Managing Partner and has the following contact phone number (843) 571-6868.

The enumeration date for this NPI number is 6/27/2006 and was last updated on 10/4/2007.

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:

Other Identifiers

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

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