Healthcare Provider Details

I. General information

NPI: 1699761874
Provider Name (Legal Business Name): DOUGLAS ELI CUNNINGHAM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 STATE RD
CHERAW SC
29520-2130
US

IV. Provider business mailing address

PO BOX 1090
HARTSVILLE SC
29551-1090
US

V. Phone/Fax

Practice location:
  • Phone: 843-537-0961
  • Fax: 843-537-0908
Mailing address:
  • Phone: 843-857-0111
  • Fax: 843-309-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number522
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number522
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: