Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2005-12-02
- Last updated
- 2023-04-24
Licenses
- License SC
- 12643
- License SC
- 12643
Location
- Practice location
- 618 N MAIN ST
- City
- MARION SC
- Postal code
- 295713034
- Phone
- 843-433-8010
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.