Provider Demographics
NPI:1164549424
Name:SANDLAPPER PEDIATRICS
Entity Type:Organization
Organization Name:SANDLAPPER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDITRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:AIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-216-9901
Mailing Address - Street 1:295 SEVEN FARMS DR
Mailing Address - Street 2:PMB 195 SUITE C
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8001
Mailing Address - Country:US
Mailing Address - Phone:843-216-9901
Mailing Address - Fax:843-216-9715
Practice Address - Street 1:570 LONG POINT RD STE 240
Practice Address - Street 2:STE. 240
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7932
Practice Address - Country:US
Practice Address - Phone:843-216-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC188484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3969Medicaid
SCGP3969Medicaid