Healthcare Provider Details

I. General information

NPI: 1497808950
Provider Name (Legal Business Name): COTY HP HO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 SINGLETON RIDGE RD
CONWAY SC
29526-9150
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number96236
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: