Provider Demographics
NPI:1093585044
Name:PPCP SPECIALTY PHYSICIANS , LLC
Entity Type:Organization
Organization Name:PPCP SPECIALTY PHYSICIANS , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR ANALYST OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JOLINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-572-7727
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-572-7727
Mailing Address - Fax:
Practice Address - Street 1:9313 MEDICAL PLAZA DR STE 202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9176
Practice Address - Country:US
Practice Address - Phone:843-572-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PPCP SPECIALTY PHYSICIANS , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty