Healthcare Provider Details

I. General information

NPI: 1700076031
Provider Name (Legal Business Name): CODY S MCCREARY H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 SPRING ST
GREENWOOD SC
29646-3831
US

IV. Provider business mailing address

3268 US HIGHWAY 441 S
OKEECHOBEE FL
34974-6239
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-6741
  • Fax: 864-227-6021
Mailing address:
  • Phone: 863-763-9700
  • Fax: 863-763-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: