Healthcare Provider Details

I. General information

NPI: 1356875264
Provider Name (Legal Business Name): PRESTON HEYWARD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 POWDERHORN RD
SIMPSONVILLE SC
29681-3399
US

IV. Provider business mailing address

111 CUMBAHEE TRL
GREENVILLE SC
29611-7809
US

V. Phone/Fax

Practice location:
  • Phone: 864-233-8175
  • Fax:
Mailing address:
  • Phone: 864-275-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: