Healthcare Provider Details

I. General information

NPI: 1336703628
Provider Name (Legal Business Name): CORRIE JOE'L DEGRAFFENREID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CHEVES ST
FLORENCE SC
29506-2650
US

IV. Provider business mailing address

800 E CHEVES ST
FLORENCE SC
29506-2650
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7555
  • Fax: 843-777-7563
Mailing address:
  • Phone: 843-777-7555
  • Fax: 843-777-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberU2473
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBP10066739
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number96705
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: