Healthcare Provider Details

I. General information

NPI: 1023165321
Provider Name (Legal Business Name): DANNY MICHAEL DOUGLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CHEVES ST STE 420
FLORENCE SC
29506-2650
US

IV. Provider business mailing address

800 E CHEVES ST STE 420
FLORENCE SC
29506-2650
US

V. Phone/Fax

Practice location:
  • Phone: 843-679-9335
  • Fax: 843-669-4214
Mailing address:
  • Phone: 843-679-9335
  • Fax: 843-669-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20813
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: