Healthcare Provider Details

I. General information

NPI: 1013541663
Provider Name (Legal Business Name): CODY K DARRINGTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 POLIFKA DR BLDG 1042
SHAW AFB SC
29152-5100
US

IV. Provider business mailing address

59 PATHFINDER DR
SUMTER SC
29150-3135
US

V. Phone/Fax

Practice location:
  • Phone: 803-895-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2496
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: