Healthcare Provider Details

I. General information

NPI: 1902302516
Provider Name (Legal Business Name): DILLARD W STEPHENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22580 HIGHWAY 76 E STE 100
LAURENS SC
29360
US

IV. Provider business mailing address

22580 HIGHWAY 76 E STE 100
LAURENS SC
29360-8460
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 Number51929
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: