Healthcare Provider Details

I. General information

NPI: 1194792804
Provider Name (Legal Business Name): JOHN H PURCELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HWY 252
ANDERSON SC
29622
US

IV. Provider business mailing address

PO BOX 485
COLUMBIA SC
29202-0485
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-8405
  • Fax:
Mailing address:
  • Phone: 803-898-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22873
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: