Healthcare Provider Details

I. General information

NPI: 1265712624
Provider Name (Legal Business Name): BARNWELL FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WREN ST
BARNWELL SC
29812-1533
US

IV. Provider business mailing address

86 WREN ST
BARNWELL SC
29812-1529
US

V. Phone/Fax

Practice location:
  • Phone: 803-259-5762
  • Fax: 803-259-3050
Mailing address:
  • Phone: 803-259-5762
  • Fax: 803-259-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARAINEY HUDSON
Title or Position: HR DIRECTOR
Credential:
Phone: 803-632-2533