Healthcare Provider Details

I. General information

NPI: 1811751043
Provider Name (Legal Business Name): FORT MILL NEUROLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 MASONS BEND DR
FORT MILL SC
29708-7061
US

IV. Provider business mailing address

1918 MASONS BEND DR
FORT MILL SC
29708-7061
US

V. Phone/Fax

Practice location:
  • Phone: 907-414-8413
  • Fax:
Mailing address:
  • Phone: 907-414-8413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID DWIGHT BUCKLAND
Title or Position: OWNER
Credential: DO
Phone: 803-412-4720