Healthcare Provider Details

I. General information

NPI: 1942544432
Provider Name (Legal Business Name): JOSEPH MICHAEL CORNWELL DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 E NATIONAL BLVD
BEAUFORT SC
29907-1773
US

IV. Provider business mailing address

47 E NATIONAL BLVD
BEAUFORT SC
29907-1773
US

V. Phone/Fax

Practice location:
  • Phone: 843-986-1142
  • Fax: 843-986-1142
Mailing address:
  • Phone: 843-986-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVET 2985
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVET 1209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: