Provider Demographics
NPI:1922323740
Name:G T LITTLE MD P.A.
Entity Type:Organization
Organization Name:G T LITTLE MD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENERAL
Authorized Official - Middle Name:THEOPHILUS
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-722-6336
Mailing Address - Street 1:280 RUTLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5352
Mailing Address - Country:US
Mailing Address - Phone:843-722-6336
Mailing Address - Fax:843-722-6302
Practice Address - Street 1:280 RUTLEDGE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5352
Practice Address - Country:US
Practice Address - Phone:843-722-6336
Practice Address - Fax:843-722-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8051261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC089511Medicaid
SCD176650281Medicare UPIN