LIBERTY DOCTORS, LLC (NPI# 1376593350) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376593350 |
| Entity Type | Organization |
| Organization Name | LIBERTY DOCTORS, LLC |
| Other Organization Name | CAROLINA FAMILY MEDICINE |
| Practice Address |
100 Springhall Dr Goose Creek SC 29445-5335 |
| Mailing Address |
Po Box 13955 Charleston SC 29422-3955 |
| Practice Telephone | 8435728201 |
| Practice Fax Number | 8437978491 |
| Mailing Telephone | 8432258304 |
| Mailing Fax Number | 8432253549 |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | MRS. SARA ELIZABETH MAYNOR-HARDY (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 8432258320 |
| Is Organization Subpart | Y |
| Parent Organization Name | LIBERTY DOCTORS LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 010197 | SC | Other Service Providers |
| Y | 207Q00000X | Family Medicine | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP0189 | 05 | |
| SC | MEDICAID GROUP NUMBER | GP0189 | 01 |
| SC | GP6738 | 05 |
| Other Name | Type Code |
|---|---|
| Carolina Family Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821443896 | Liberty Doctors, LLC | Family Medicine | 9275 D Medical Plaza Dr., North Charleston, SC 29406 | 2016-04-27 |
| 1376854406 | Liberty Doctors, LLC | Family Medicine | 8761 Dorchester Rd, Suite 230, North Charleston, SC 29420-7322 | 2010-06-23 |
| 1144421330 | Liberty Doctors, LLC | Family Medicine | 1405 Ben Sawyer Blvd, Ste 105, Mt Pleasant, SC 29464 | 2007-05-29 |
| 1508928656 | Liberty Doctors, LLC | Specialist | 6518 Dorchester Rd Ste B, Charleston, SC 29418-5100 | 2006-12-15 |
| 1053954909 | Liberty Doctors, LLC | Family Medicine | 297 Seven Farms Dr Ste 202, Daniel Island, SC 29492-7553 | 2019-10-23 |
| 1194380162 | Liberty Doctors, LLC | Internal Medicine | 2270 Ashley Crossing Dr Ste 165, Charleston, SC 29414-5865 | 2019-05-06 |
| 1588119556 | Liberty Doctors, LLC | Pediatrics | 215 Town Creek Rd, Aiken, SC 29803-5843 | 2016-08-19 |
| 1689129652 | Liberty Doctors, LLC | Family Medicine | 21 Gamecock Ave, Charleston, SC 29407-3368 | 2016-08-19 |
| 1689051369 | Liberty Doctors, LLC | Family Medicine | 418 Folly Rd Ste A, Charleston, SC 29412-2625 | 2015-05-01 |
| 1881639862 | Liberty Doctors, LLC | Family Medicine | 1483 Tobias Gadson Blvd, Suite 206, Charleston, SC 29407-8702 | 2006-06-16 |
| Street Address |
100 SPRINGHALL DR |
| City | GOOSE CREEK |
| State | SC |
| Zip Code | 29445-5335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871577460 | Antonio Hernandez | Internal Medicine | 100 Springhall Dr, Goose Creek, SC 29445-5335 | 2005-12-06 |
| 1134726052 | Lauren Virginia Lamendola | Physician Assistant | 100 Springhall Dr, Goose Creek, SC 29445-5335 | 2020-10-04 |
| 1346676277 | Cynthia Lynn Cuson | Nurse Practitioner | 100 Springhall Dr, Goose Creek, SC 29445-5335 | 2013-09-24 |
| 1861753204 | Denise Knox Hosenfeld | Nurse Practitioner | 100 Springhall Dr, Goose Creek, SC 29445-5335 | 2012-06-01 |
| 1558459453 | John White Campbell IIi | Family Medicine | 100 Springhall Dr, Goose Creek, SC 29445-5335 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790309953 | Auriel Mcconnell | Home Health | 616 One Mans Court, Mount Pleasant, SC 29445 | 2020-06-03 |
| 1215594023 | Tanova Cornise Robinson | Counselor | 96 Wisteria Road, Goose Creek, SC 29445 | 2019-05-28 |
| 1417421777 | Debra Liana Kerness | Social Worker | 100-a Central Avenue, Suite 203, Goose Creek, SC 29445 | 2019-01-18 |
| 1043663503 | Aimee Nehiley | Dentist | 615 Saint James Ave, Goose Creek, SC 29445 | 2016-07-20 |
| 1881057032 | Eddie Emanuel Nance | Family Medicine | 110 Naval Nuclear Power Training Command Cir, Goose Creek, SC 29445 | 2016-04-04 |
| 1295195188 | Dental Professionals of South Carolina, PC | Dentist | 615 St. James Ave, Goose Creek, SC 29445 | 2016-03-04 |
| 1144603622 | Laryssa Smith | Pharmacist | 215 St. James Ave, Goose Creek, SC 29445 | 2015-07-02 |
| 1730439126 | O'stacia Williamson | Pharmacist | 1316 Redbank Rd, 9, Goose Creek, SC 29445 | 2012-09-13 |
| 1164771275 | Mary Ashley Watts | Pharmacist | 431 B St James Ave Suite I, Goose Creek, SC 29445 | 2012-09-05 |
| 1598048860 | Brianne Michele Terry | Pharmacist | 142 East Saint James Ave, Goose Creek, SC 29445 | 2011-09-23 |
| Find all providers in zip 29445 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881057032 | Eddie Emanuel Nance | Family Medicine | 110 Naval Nuclear Power Training Command Cir, Goose Creek, SC 29445 | 2016-04-04 |
| 1154564359 | Roper Saint Francis Physicians Network | Family Medicine | 120 Spring Hall Dr, Suite B, Goose Creek, SC 29445-5335 | 2009-04-17 |
| 1730359167 | Sylvia S Barnes | Family Medicine | 101 New Castle Loop, Goose Creek, SC 29445 | 2008-02-29 |
| 1073702957 | Primecare Family Practice LLC | Family Medicine | 145 St James Ave, Goose Creek, SC 29445-2923 | 2007-10-17 |
| 1144233735 | Titus Daniel Caddell Sr. | Family Medicine | 588 Old Mount Holly Rd, Goose Creek, SC 29445-2814 | 2006-08-14 |
| 1922015692 | Adebola E Rojugbokan | Family Medicine | 149 St James Ave, Goose Creek, SC 29445-2923 | 2006-08-02 |
| 1205877198 | Leah S Trantham | Family Medicine | 149 Saint James Ave, Goose Creek, SC 29445-2923 | 2006-06-09 |
| 1245271261 | Palmetto Primary Care Physicians | Family Medicine | 7 South Alliance Drive, Ste 201a, Goose Creek, SC 29445 | 2006-06-09 |
| 1780636423 | John Douglas Sutterlin IIi | Family Medicine | 7 S Alliance Dr Ste 211b, Goose Creek, SC 29445-7269 | 2006-05-17 |
| 1336199629 | Lowcountry Medical Associates | Family Medicine | 110 Springhall Dr, Goose Creek, SC 29445-5335 | 2006-05-10 |
| Find all providers in GOOSE CREEK | ||||
| City | GOOSE CREEK |
| Zip Code | 29445 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.