Healthcare Provider Details

I. General information

NPI: 1427037167
Provider Name (Legal Business Name): MARION REYNOLDS MCMILLAN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 EAST CHEVES STREET, FLORENCE, SC 29506-2710
FLORENCE SC
29506-2710
US

IV. Provider business mailing address

457 E BYPASS 123
SENECA SC
29678
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7010
  • Fax: 843-777-5572
Mailing address:
  • Phone: 864-886-9888
  • Fax: 864-886-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15608
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15608
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number15608
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number15608
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: