Healthcare Provider Details

I. General information

NPI: 1164477998
Provider Name (Legal Business Name): DONALD WAIN MORANDO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 HIGHWAY 707 STE 100
MYRTLE BEACH SC
29588-7321
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTENTION PNS CREDENTIALING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-234-8939
  • Fax: 843-234-8959
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82256
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: