Healthcare Provider Details

I. General information

NPI: 1477644623
Provider Name (Legal Business Name): JOSEPH R CUNNINGHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 UNIVERSITY PARKWAY
AIKEN SC
29801
US

IV. Provider business mailing address

302 UNIVERSITY PARKWAY
AIKEN SC
29801
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-5000
  • Fax: 803-641-5670
Mailing address:
  • Phone: 803-641-5000
  • Fax: 803-641-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number8089
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: