Healthcare Provider Details

I. General information

NPI: 1841827011
Provider Name (Legal Business Name): JOHN CORGAN CONWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA SC
29203-6896
US

IV. Provider business mailing address

1 GUSTAVE L. LEVY PLACE BOX 1264
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-1663
  • Fax: 803-434-7092
Mailing address:
  • Phone: 212-241-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number342204
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number342204
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number92088
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: