Provider Demographics
NPI:1275721466
Name:GEORGETOWN PODIATRY GROUP PC
Entity Type:Organization
Organization Name:GEORGETOWN PODIATRY GROUP PC
Other - Org Name:PAWLEYS PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SPRINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-235-0002
Mailing Address - Street 1:10593 OCEAN HWY
Mailing Address - Street 2:UNIT B
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8543
Mailing Address - Country:US
Mailing Address - Phone:843-235-0002
Mailing Address - Fax:834-235-0014
Practice Address - Street 1:10593 OCEAN HWY
Practice Address - Street 2:UNIT B
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-8543
Practice Address - Country:US
Practice Address - Phone:843-235-0002
Practice Address - Fax:834-235-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0105213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5265Medicare PIN