Healthcare Provider Details

I. General information

NPI: 1124123740
Provider Name (Legal Business Name): DAVID THERON SAULS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CARTER PARK DR STE 3A
SENECA SC
29678-1152
US

IV. Provider business mailing address

109 CARTER PARK DR STE 3A
SENECA SC
29678-1152
US

V. Phone/Fax

Practice location:
  • Phone: 864-885-0058
  • Fax:
Mailing address:
  • Phone: 864-885-0058
  • Fax: 864-885-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number026644
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26644
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number26644
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86485
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: