LIBERTY DOCTORS LLC (NPI# 1659831246) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659831246 |
| Entity Type | Organization |
| Organization Name | LIBERTY DOCTORS LLC |
| Other Organization Name | SIMPLE MEDICINE |
| Practice Address |
1064 Gardner Rd Ste 105-106 Charleston SC 29407-5768 |
| Mailing Address |
Po Box 13955 Charleston SC 29422-3955 |
| Practice Telephone | 8544291175 |
| Practice Fax Number | 8436959467 |
| Mailing Telephone | 8432258320 |
| Mailing Fax Number | 8432253549 |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | 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 |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | MEDICARE PTAN | A634 | 01 |
| SC | GP6738 | 05 |
| Other Name | Type Code |
|---|---|
| Simple Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700162203 | Liberty Doctors LLC | Clinical Nurse Specialist | 8761 Dorchester Rd Ste 230, Charleston, SC 29420-7322 | 2011-10-27 |
| 1760083562 | Liberty Doctors LLC | Family Medicine | 9133 Timber St, North Charleston, SC 29406-9075 | 2020-11-06 |
| 1558928614 | Liberty Doctors LLC | Pediatrics | 3800 Faber Place Dr, Charleston, SC 29405-8532 | 2019-05-23 |
| 1013477827 | Liberty Doctors LLC | Internal Medicine | 2270 Ashley Crossing Dr Ste 155, Charleston, SC 29414-5749 | 2019-03-20 |
| 1184169799 | Liberty Doctors LLC | Family Medicine | 110a Springhall Dr, Goose Creek, SC 29445-5335 | 2017-01-05 |
| 1164964904 | Liberty Doctors LLC | Family Medicine | 1477 Tobias Gadson Blvd, Charleston, SC 29407-4794 | 2016-11-10 |
| 1063954956 | Liberty Doctors LLC | Family Medicine | 110a Springhall Dr, Goose Creek, SC 29445-5335 | 2016-11-09 |
| Street Address |
1064 GARDNER RD STE 105-106 |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29407-5768 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124226006 | Douglas Harold Gleaton II | Family Medicine | 1064 Gardner Rd Ste 105-106, Charleston, SC 29407-5768 | 2007-07-03 |
| 1174939219 | Amanda U. Green | Registered Nurse | 1064 Gardner Rd Ste 105-106, Charleston, SC 29407-5768 | 2014-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437763661 | Charleston Jaw Surgery | Oral & Maxillofacial Surgery | 846 St. Andrews Blvd., Charleston, SC 29407 | 2020-09-04 |
| 1780225128 | New Endeavors Counseling | Social Worker | 1 Carriage Lane Building E Suite 202, Charleston, SC 29407 | 2019-10-07 |
| 1770063158 | Katelyn Campbell | Psychologist | 1 Carriage Ln Ste 102, Charleston, SC 29407 | 2018-08-15 |
| 1164929956 | Anisha Gulati Md LLC | Psychiatry & Neurology | 925 Wappoo Rd., Suite F, Charleston, SC 29407 | 2018-04-09 |
| 1316459753 | David W Richardson | Dentist | 765 St. Andrews Blvd., Charleston, SC 29407 | 2017-10-25 |
| 1457874174 | Meca Mentality LLC | Chiropractor | 1106 St Andrews Blvd Suite A, Charleston, SC 29407 | 2017-07-25 |
| 1639609373 | Carolina Behavioral Specialists, LLC | Behavioral Analyst | 1529 Sam Rittenberg Blvd, Unit 1-b, Charleston, SC 29407 | 2017-06-15 |
| 1467991901 | Bernice Ladson | Registered Nurse | 75o Magnolia Road, Charleston, SC 29407 | 2017-02-16 |
| 1376991257 | Virginia Leigh Thomason | Counselor | 29 Leinbach Dr, Suite D2, Charleston, SC 29407 | 2016-06-01 |
| 1609221001 | Elinor Lee Smith | Counselor | 571 Savannah Hwy, Charleston, SC 29407 | 2016-05-04 |
| Find all providers in zip 29407 | ||||
| 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 |
|---|---|---|---|---|
| 1811595499 | Laura Coolidge | Family Medicine | 1528 Seacroft Rd, Charleston, SC 29412-8113 | 2020-10-15 |
| 1356954259 | Relymd Medical Group Wv, Pllc | Family Medicine | 1627 Quarrier St, Charleston, WV 25311-2124 | 2020-08-28 |
| 1922617950 | Fred E Hill | Family Medicine | 1033 Jervey Point Rd, Charleston, SC 29492-8372 | 2020-07-27 |
| 1093375222 | Valley Health Systems, Inc. | Family Medicine | 333 Laidley St Fl 6, Charleston, WV 25301-1614 | 2019-06-19 |
| 1427512201 | Catherine Courtney Slemp | Family Medicine | 350 Capitol St Rm 702, Charleston, WV 25301-1757 | 2019-01-25 |
| 1730677709 | Courtney Uhlar | Family Medicine | 169 Ashley Ave # Msc333, Charleston, SC 29425-9125 | 2018-04-25 |
| 1134617335 | Kelsey Rose Wilson | Family Medicine | 169 Ashley Ave. Room 202, Main Hospital Msc 333, Charleston, SC 29425-9125 | 2018-04-24 |
| 1659869816 | Anthony James Baglio | Family Medicine | 169 Ashley Avenue, Room 202 Main Hospital, Msc 333, Charleston, SC 29425 | 2018-04-24 |
| 1396252219 | Lisa Ann Oshaughnessy Turnure | Family Medicine | 3 Sawgrass Rd Apt I6, Charleston, SC 29412-2579 | 2017-12-30 |
| 1720467525 | Sasha M. Perez | Family Medicine | 3030 Ashley Town Center Dr Ste 102a, Charleston, SC 29414 | 2015-05-26 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 29407 |
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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.