Provider Demographics
NPI:1669878559
Name:TIDELANDS GHS JOINT VENTURE LLC
Entity type:Organization
Organization Name:TIDELANDS GHS JOINT VENTURE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:DOAR
Authorized Official - Last Name:STALVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-546-3410
Mailing Address - Street 1:2591 N FRASER ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-6411
Mailing Address - Country:US
Mailing Address - Phone:843-546-3410
Mailing Address - Fax:843-527-6964
Practice Address - Street 1:2591 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-6411
Practice Address - Country:US
Practice Address - Phone:843-546-3410
Practice Address - Fax:843-527-6964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIDELANDS GHS JOINT VENTURE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-05
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty