Healthcare Provider Details

I. General information

NPI: 1710501242
Provider Name (Legal Business Name): WALKER MACKENZIE HEFFRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 N HIGHWAY 17 STE 220
MT PLEASANT SC
29466-8245
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-853-3474
  • Fax: 843-853-3500
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number84209
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: