Healthcare Provider Details

I. General information

NPI: 1386642189
Provider Name (Legal Business Name): WINSTON MCIVER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 SINGLETON RIDGE RD SUITE A
CONWAY SC
29526
US

IV. Provider business mailing address

660 SINGLETON RIDGE RD SUITE A
CONWAY SC
29526
US

V. Phone/Fax

Practice location:
  • Phone: 843-234-4362
  • Fax: 843-234-9057
Mailing address:
  • Phone: 843-234-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22160
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: