Healthcare Provider Details

I. General information

NPI: 1851575518
Provider Name (Legal Business Name): GAFFNEY HMA PHYSICIAN MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PROFESSIONAL PARK SUITE A
GAFFNEY SC
29340-2319
US

IV. Provider business mailing address

104 PROFESSIONAL PARK SUITE A
GAFFNEY SC
29340-2319
US

V. Phone/Fax

Practice location:
  • Phone: 864-488-3336
  • Fax: 864-488-4439
Mailing address:
  • Phone: 864-488-3336
  • Fax: 864-488-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number13832
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number13832
License Number StateSC

VIII. Authorized Official

Name: STANLEY D. MCLEMORE
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 229-598-3131