Healthcare Provider Details

I. General information

NPI: 1871971168
Provider Name (Legal Business Name): RALEIGH NOREAN RUMLEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 HOLMESTOWN ROAD SUITE E1
MYRTLE BEACH SC
29588-9138
US

IV. Provider business mailing address

PO BOX 547
LITTLE RIVER SC
29566-0547
US

V. Phone/Fax

Practice location:
  • Phone: 843-663-8000
  • Fax: 843-663-8123
Mailing address:
  • Phone: 843-663-8000
  • Fax: 843-663-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209264
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52089
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: