Healthcare Provider Details

I. General information

NPI: 1710940531
Provider Name (Legal Business Name): HOWARD G. ROYAL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 HITCHCOCK PARKWAY
AIKEN SC
29801
US

IV. Provider business mailing address

PO BOX 2510
EVANS GA
30809-2510
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-6941
  • Fax: 803-649-7966
Mailing address:
  • Phone: 706-650-7799
  • Fax: 706-650-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7983
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: