NPI 1366519530

Provident Health Services, INC.

Organisation Surgery Physician Bluffton, SC

Practice location

Address: 7 Mallet Way, Bluffton, SC 29910-6064
Phone: (912) 350-7412
Fax: (912) 350-7297
Mailing address: PO Box 933213, Atlanta, GA 31193-1968

Authorised official

Name: Robin J. Maddox
Title: Provider Enrollment Coordinator
Phone: (912) 350-9335

Registered specialties (2)

Surgery Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208600000X

Other Surgery providers in South Carolina →

Surgical Oncology Physician

Allopathic & Osteopathic Physicians Taxonomy 2086X0206X

Registry record

NPI: 1366519530
Entity type: Organization
NPI issued: 30 Nov 2006
Record last updated: 11 Sep 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.