Healthcare Provider Details

I. General information

NPI: 1205332434
Provider Name (Legal Business Name): JOSEPH LANDON MCKINLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 11/20/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 BOULEVARD DE FRANCE
PARRIS ISLAND SC
29905-0000
US

IV. Provider business mailing address

670 BOULEVARD DE FRANCE
PARRIS ISLAND SC
29905
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-5600
  • Fax:
Mailing address:
  • Phone: 843-228-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2060
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2060
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: