Healthcare Provider Details

I. General information

NPI: 1073868097
Provider Name (Legal Business Name): NAJLA ITANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SINGLETON RIDGE ROAD
CONWAY SC
29526-9142
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTENTION PATIENT ACCOUNTING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-8050
  • Fax: 843-347-8049
Mailing address:
  • Phone: 843-234-6946
  • Fax: 843-234-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number82438
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: