Healthcare Provider Details

I. General information

NPI: 1679782866
Provider Name (Legal Business Name): MICHAEL KENNETH FOXWORTH II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 2ND LOOP RD
FLORENCE SC
29501-6123
US

IV. Provider business mailing address

360 N IRBY ST
FLORENCE SC
29501-2808
US

V. Phone/Fax

Practice location:
  • Phone: 843-432-3700
  • Fax: 843-667-1362
Mailing address:
  • Phone: 843-667-9414
  • Fax: 843-667-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35471
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number35471
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: