Healthcare Provider Details

I. General information

NPI: 1801882527
Provider Name (Legal Business Name): JOHN S MCCOWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 E CHEVES ST
FLORENCE SC
29506-2616
US

IV. Provider business mailing address

506 E CHEVES ST P.O. BOX 1905
FLORENCE SC
29506-2616
US

V. Phone/Fax

Practice location:
  • Phone: 843-413-3100
  • Fax: 843-413-3199
Mailing address:
  • Phone: 843-413-3100
  • Fax: 843-413-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number17932
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number17932
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: