1366407231 NPI number — F. MARION DWIGHT, MD,PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366407231 NPI number — F. MARION DWIGHT, MD,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
F. MARION DWIGHT, MD,PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366407231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAMBERG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29003-0120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-245-5168
Provider Business Mailing Address Fax Number:
803-245-6275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2113 MAIN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAMBERG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29003-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-245-5168
Provider Business Practice Location Address Fax Number:
803-245-6275
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCALHANEY
Authorized Official First Name:
DANETTE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
803-245-5168

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP0698 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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