Provider Demographics
NPI:1851659502
Name:SOUTHEASTERN FERTILITY CENTER II, PA
Entity Type:Organization
Organization Name:SOUTHEASTERN FERTILITY CENTER II, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:W
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-881-3900
Mailing Address - Street 1:1375 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3254
Mailing Address - Country:US
Mailing Address - Phone:843-881-3900
Mailing Address - Fax:843-284-2473
Practice Address - Street 1:1375 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3254
Practice Address - Country:US
Practice Address - Phone:843-881-3900
Practice Address - Fax:843-284-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty