Healthcare Provider Details

I. General information

NPI: 1871519355
Provider Name (Legal Business Name): JANET BLAIR REOWN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WACCAMAW MEDICAL PARK DR
CONWAY SC
29526-8903
US

IV. Provider business mailing address

7912 PENNYROYAL RD
GEORGETOWN SC
29440-5139
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-5060
  • Fax:
Mailing address:
  • Phone: 843-527-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: