Healthcare Provider Details

I. General information

NPI: 1932168986
Provider Name (Legal Business Name): EUGENE M. GIDDENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 DOUG WHITE DR STE 460
MYRTLE BEACH SC
29572-4182
US

IV. Provider business mailing address

920 DOUG WHITE DR STE 460
MYRTLE BEACH SC
29572-4182
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-2336
  • Fax: 843-497-0625
Mailing address:
  • Phone: 843-449-2336
  • Fax: 843-497-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number15143
License Number StateSC

VII. Legacy identifiers

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

# 1
Identifier0604782
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerPHP
# 2
Identifier1000742
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerEVOLUTIONS
# 3
Identifier015143600
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 4
Identifier01838955
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier5402760
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerAETNA
# 6
Identifier1061024
Identifier TypeOTHER
Identifier StateWV
Identifier IssuerWORK COMP
# 7
Identifier690570Y
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: