Healthcare Provider Details

I. General information

NPI: 1760501407
Provider Name (Legal Business Name): MARK CURTIS CUNDIFF CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CHANTILLY RUE CT
SIMPSONVILLE SC
29681-5365
US

IV. Provider business mailing address

11 CHANTILLY RUE CT
SIMPSONVILLE SC
29681-5365
US

V. Phone/Fax

Practice location:
  • Phone: 828-691-1338
  • Fax: 864-688-2020
Mailing address:
  • Phone: 828-691-1338
  • Fax: 864-688-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number102321
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: