Healthcare Provider Details

I. General information

NPI: 1679924344
Provider Name (Legal Business Name): AUSTIN LEE ROACH MCJUNKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LAKESHORE PKWY
ROCK HILL SC
29730-4205
US

IV. Provider business mailing address

455 LAKESHORE PKWY
ROCK HILL SC
29730-4205
US

V. Phone/Fax

Practice location:
  • Phone: 803-909-6363
  • Fax: 877-658-8669
Mailing address:
  • Phone: 803-909-6363
  • Fax: 803-909-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39563
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2018-01199
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL39563
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2018-01199
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: