Healthcare Provider Details

I. General information

NPI: 1831652718
Provider Name (Legal Business Name): HAYTHAM AHMAD ABOUSHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 CYPRESS CIR STE 102
CONWAY SC
29526-8964
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTN CREDENTIALING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-8953
  • Fax: 843-347-0226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number97478
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: