Healthcare Provider Details

I. General information

NPI: 1881623601
Provider Name (Legal Business Name): WINDHAM GYNECOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S COIT ST
FLORENCE SC
29501-5220
US

IV. Provider business mailing address

509 S COIT ST
FLORENCE SC
29501-5220
US

V. Phone/Fax

Practice location:
  • Phone: 843-676-1435
  • Fax: 843-676-1437
Mailing address:
  • Phone: 843-676-1435
  • Fax: 843-676-1437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number149324
License Number StateSC

VIII. Authorized Official

Name: MRS. NANCY WINDHAM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 843-676-1435