Provider Demographics
NPI:1700134186
Name:LOWCOUNTRY NEUROPATHY OF HILTON HEAD, LLC
Entity Type:Organization
Organization Name:LOWCOUNTRY NEUROPATHY OF HILTON HEAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LUCKIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-817-7404
Mailing Address - Street 1:4222 FLYNN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-6784
Mailing Address - Country:US
Mailing Address - Phone:843-817-7404
Mailing Address - Fax:843-529-0234
Practice Address - Street 1:55A SHERIDAN PARK CIR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6025
Practice Address - Country:US
Practice Address - Phone:843-817-7404
Practice Address - Fax:843-529-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1427030212OtherPROVIDER NPI