Healthcare Provider Details

I. General information

NPI: 1528001161
Provider Name (Legal Business Name): LOUIS M STEPHENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22580 HIGHWAY 76 E SUITE 100
LAURENS SC
29360-8439
US

IV. Provider business mailing address

22580 HIGHWAY 76 E SUITE 100
LAURENS SC
29360-8439
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-5986
  • Fax: 864-833-0599
Mailing address:
  • Phone: 864-833-5986
  • Fax: 864-833-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12905
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: