1316944499 NPI number — DOUGLAS CONAWAY M.D.

Table of content: DOUGLAS CONAWAY M.D. (NPI 1316944499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316944499 NPI number — DOUGLAS CONAWAY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONAWAY
Provider First Name:
DOUGLAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1316944499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3439
Provider Second Line Business Mailing Address:
NORTH MYRTLE BEACH
Provider Business Mailing Address City Name:
NORTH MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29582-0439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-839-4447
Provider Business Mailing Address Fax Number:
843-399-0123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 82ND PKWY
Provider Second Line Business Practice Location Address:
MYRTLE BEACH
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29572-4610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-497-5929
Provider Business Practice Location Address Fax Number:
877-316-4124
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  19126 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: T31926 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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