East Cooper Physician Group LLC
Internal Medicine in Mt Pleasant, SC. Organization (NPI-2).
NPI number1790546232
StatusActive
Last updated in NPPESJan 22, 2024
Details
- NPI
- 1790546232
- Entity type
- Organization (NPI-2)
- Legal business name
- East Cooper Physician Group LLC
- Organization subpart
- No
- Enumeration date
- Jan 22, 2024
- Certification date
- Jan 17, 2024
- Last updated
- Jan 22, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
Other names
- Revela Assisted Living (Doing Business As)
Practice location
1047 Anna Knapp BlvdMt Pleasant, SC 29464-3146
Phone 843-884-7977
Mailing address
Po Box 37642Belfast, ME 04915-1218
Authorized official
Doreatha Rogers
Rcs Manager
9803027992
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