Healthcare Provider Details

I. General information

NPI: 1528449394
Provider Name (Legal Business Name): MICHAEL DEAN SIGSWORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MEDICAL PARK, STE 141 GENERAL PSYCHIATRY DEPT
COLUMBIA SC
29203
US

IV. Provider business mailing address

15 MEDICAL PARK, STE 141 GENERAL PSYCHIATRY DEPT
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-1433
  • Fax: 803-434-4062
Mailing address:
  • Phone: 803-434-1433
  • Fax: 803-434-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL38482
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: