Provider Demographics
NPI:1417315771
Name:HARDEEVILLE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:HARDEEVILLE MEDICAL GROUP, LLC
Other - Org Name:MEDICAL ASSOCIATES OF THE LOWCOUNTRY GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:PO BOX 741905
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1905
Mailing Address - Country:US
Mailing Address - Phone:843-645-8220
Mailing Address - Fax:843-645-8221
Practice Address - Street 1:1010 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-3447
Practice Address - Country:US
Practice Address - Phone:843-645-8220
Practice Address - Fax:843-645-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty