Provider Demographics
NPI:1194704155
Name:GRIM, PAMELA SUE (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:GRIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SEA GULL DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1314
Mailing Address - Country:US
Mailing Address - Phone:843-441-3104
Mailing Address - Fax:843-441-3104
Practice Address - Street 1:32 SEA GULL DRIVE
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-6148
Practice Address - Country:US
Practice Address - Phone:843-441-3104
Practice Address - Fax:843-441-3104
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26600207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC266009Medicaid
SC266009Medicaid
SCC393398822Medicare PIN
SCC39339Medicare UPIN