42D2145618 CLIA NUMBER - TIDEWATER DOCTORS LLC

Laboratory Demographics

CLIA Number: 42D2145618

Facility Name: TIDEWATER DOCTORS LLC

Facility Address:
2270 ASHLEY CROSSING DR, SUITE 155
CHARLESTON, SC
ZIP 29414
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Facility Phone Number: 843 990-5866

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821769290

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name	Field Value
CLIA Number	42D2145618
LAB Type	Physician Office
Facility Name	TIDEWATER DOCTORS LLC
Street	2270 ASHLEY CROSSING DR, SUITE 155
City	CHARLESTON
State	SC
ZIP	29414
Phone	843 990-5866
CertificateType	4
CertificateEffectiveDate	3/13/2024
CertificateExpirationDate	3/12/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024