Healthcare Provider Details

I. General information

NPI: 1528245560
Provider Name (Legal Business Name): NATHAN PATRICK JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 HIGHWAY 707
MYRTLE BEACH SC
29588-7304
US

IV. Provider business mailing address

7410 HIGHWAY 707
MYRTLE BEACH SC
29588-7304
US

V. Phone/Fax

Practice location:
  • Phone: 843-215-1100
  • Fax: 843-215-1211
Mailing address:
  • Phone: 843-215-1100
  • Fax: 843-215-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number30586
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number30586
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30569
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: