Healthcare Provider Details

I. General information

NPI: 1841305679
Provider Name (Legal Business Name): SCOTT MORRIS BERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HIGHWAY 9 E STE 245
LITTLE RIVER SC
29566-7833
US

IV. Provider business mailing address

506 E CHEVES ST STE 202
FLORENCE SC
29506-2616
US

V. Phone/Fax

Practice location:
  • Phone: 843-366-2940
  • Fax: 843-366-2470
Mailing address:
  • Phone: 843-777-5091
  • Fax: 843-777-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number14869
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: