Healthcare Provider Details

I. General information

NPI: 1912985219
Provider Name (Legal Business Name): JOHN R NOBLES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/13/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 COVINGTON MILL POUD RD
BENNETTSVILLE SC
29512-7177
US

IV. Provider business mailing address

577 COVINGTON MILL POUD RD
BENNETTSVILLE SC
29512-7177
US

V. Phone/Fax

Practice location:
  • Phone: 843-454-7177
  • Fax: 843-479-8347
Mailing address:
  • Phone: 843-454-7177
  • Fax: 843-479-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10891
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: