Healthcare Provider Details

I. General information

NPI: 1649239989
Provider Name (Legal Business Name): WACCAMAW ONCOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 N FRASER ST
GEORGETOWN SC
29440-6410
US

IV. Provider business mailing address

2405 N FRASER ST
GEORGETOWN SC
29440-6410
US

V. Phone/Fax

Practice location:
  • Phone: 843-545-7274
  • Fax: 843-546-7353
Mailing address:
  • Phone: 843-545-7274
  • Fax: 843-546-7353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DARREN EUGENE MULLINS
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 843-545-7274