Provider Demographics
NPI:1518383637
Name:HERITAGE MEDICAL GROUP OF HILTON HEAD, LLC
Entity Type:Organization
Organization Name:HERITAGE MEDICAL GROUP OF HILTON HEAD, LLC
Other - Org Name:HILTON HEAD PARTNERS
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 742987
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2987
Mailing Address - Country:US
Mailing Address - Phone:843-681-5305
Mailing Address - Fax:843-689-5210
Practice Address - Street 1:460 WILLIAM HILTON PKWY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2497
Practice Address - Country:US
Practice Address - Phone:843-681-5305
Practice Address - Fax:843-689-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty