| Organization Name: | ADVANCED MEDICAL ASSOCIATES OF SUMMERVILLE |
| NPI Number: | 1790748150 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JON LLOYD ETHERIDGE (PRESIDENT) |
| Mailing Address: | 1711 N Main St Summerville |
| State: | SC US |
| Postal Code: | 294837807 |
| Phone Number: | 8438752268 |
| Fax Number: | 8438752267 |
| NPI Enumeration Date: | 04/07/2006 |
| NPI Last Update Date: | 08/03/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 15987 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |