Provider Demographics
NPI:1619014487
Name:NORTH MYRTLE BEACH FAMILY PRACTICE
Entity Type:Organization
Organization Name:NORTH MYRTLE BEACH FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GARNETT
Authorized Official - Last Name:RAMSLATTORN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-249-2451
Mailing Address - Street 1:86 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3112
Mailing Address - Country:US
Mailing Address - Phone:843-249-2451
Mailing Address - Fax:843-249-4100
Practice Address - Street 1:86 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3112
Practice Address - Country:US
Practice Address - Phone:843-249-2451
Practice Address - Fax:843-249-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC092642Medicaid
SC29670OtherMEDCAST
SC092642Medicaid
SC6337Medicare PIN