| Liberty Doctors, Llc | |
|
1483 Tobias Gadson Blvd Suite 206 Charleston SC 29407-8702 | |
| (843) 766-1936 | |
| (843) 766-1206 |
| Full Name | Liberty Doctors, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1483 Tobias Gadson Blvd, Charleston, South Carolina |
| Authorized Official Name and Position | Sara Elizabeth Maynor-hardy (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 8432258320 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Liberty Doctors, Llc Po Box 13955 Charleston SC 29422-3955 Ph: (843) 225-8304 | Liberty Doctors, Llc 1483 Tobias Gadson Blvd Suite 206 Charleston SC 29407-8702 Ph: (843) 766-1936 |
| NPI Number | 1881639862 |
|---|---|
| Provider Enumeration Date | 06/16/2006 |
| Last Update Date | 10/21/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881639862 | NPI | - | NPPES |
| GP3558 | Medicaid | SC | |
| GP6738 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | SC0310 (South Carolina) | Secondary |
| 207Q00000X | Family Medicine | (South Carolina) | Primary |
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