Healthcare Provider Details

I. General information

NPI: 1184373565
Provider Name (Legal Business Name): NICHOLAS ALEXANDER BUSKILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

2807 WILLOWICK TRL SE
OWENS CROSS ROADS AL
35763-8689
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-8340
  • Fax: 843-692-1122
Mailing address:
  • Phone: 334-559-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4611
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: