Provider Demographics
NPI:1396763264
Name:LOWCOUNTRY OBSTETRICS AND GYNECOLOGY
Entity type:Organization
Organization Name:LOWCOUNTRY OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY (MOLLY)
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-972-2361
Mailing Address - Street 1:1300 HOSPITAL DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3261
Mailing Address - Country:US
Mailing Address - Phone:843-884-5133
Mailing Address - Fax:843-849-3343
Practice Address - Street 1:1300 HOSPITAL DR
Practice Address - Street 2:SUITE 270
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3261
Practice Address - Country:US
Practice Address - Phone:843-884-5133
Practice Address - Fax:843-849-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2820Medicaid
SCGP2820Medicaid