Healthcare Provider Details

I. General information

NPI: 1689048464
Provider Name (Legal Business Name): ABBEVILLE COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 COLLEGE ST
DUE WEST SC
29639-9554
US

IV. Provider business mailing address

PO BOX 887
ABBEVILLE SC
29620-0887
US

V. Phone/Fax

Practice location:
  • Phone: 864-379-2345
  • Fax: 864-379-3228
Mailing address:
  • Phone: 864-366-5011
  • Fax: 864-366-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY MARGARET JACKSON
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 864-366-3279