| Tidewater Doctors Llc | |
|
2270 Ashley Crossing Dr Ste 150 Charleston SC 29414-5702 | |
| (843) 766-1936 | |
| (843) 766-1206 |
| Full Name | Tidewater Doctors Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2270 Ashley Crossing Dr Ste 150, Charleston, South Carolina |
| Authorized Official Name and Position | Andrea Hurley (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 8432007721 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Doctors Llc 2834 Aquaduct St Charleston SC 29414-7410 Ph: (843) 200-7721 | Tidewater Doctors Llc 2270 Ashley Crossing Dr Ste 150 Charleston SC 29414-5702 Ph: (843) 766-1936 |
| NPI Number | 1992474654 |
|---|---|
| Provider Enumeration Date | 09/07/2021 |
| Last Update Date | 09/07/2021 |
| Medicare PECOS PAC ID | 2466841655 |
|---|---|
| Medicare Enrollment ID | O20211109001955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992474654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Jeffrey M Akhtar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053370841 PECOS PAC ID: 3072584739 Enrollment ID: I20051122000467 |
| Provider Name | Donald P Hurley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043206410 PECOS PAC ID: 6901811009 Enrollment ID: I20100921000255 |
| Provider Name | Amelia C Fairfax |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629147848 PECOS PAC ID: 3779753934 Enrollment ID: I20110825000082 |
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