Healthcare Provider Details

I. General information

NPI: 1225482524
Provider Name (Legal Business Name): ADAM MICHAEL GUDE NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 CHERAW ST
BENNETTSVILLE SC
29512-2420
US

IV. Provider business mailing address

PO BOX 1090
HARTSVILLE SC
29551-1090
US

V. Phone/Fax

Practice location:
  • Phone: 843-479-2341
  • Fax:
Mailing address:
  • Phone: 843-857-0111
  • Fax: 843-857-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20111
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: