Healthcare Provider Details

I. General information

NPI: 1275685000
Provider Name (Legal Business Name): MARK JOHNSON QUARTERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 CARDINAL CIR
ANDERSON SC
29621-1504
US

IV. Provider business mailing address

2022 CARDINAL CIR
ANDERSON SC
29621-1504
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-7577
  • Fax: 864-225-5165
Mailing address:
  • Phone: 864-224-7577
  • Fax: 864-225-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number16908
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number16908
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number16908
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: