Healthcare Provider Details

I. General information

NPI: 1134277882
Provider Name (Legal Business Name): MARY M VARN, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E BLACKSTOCK RD STE J
SPARTANBURG SC
29301-2652
US

IV. Provider business mailing address

233 E BLACKSTOCK RD STE J
SPARTANBURG SC
29301-2652
US

V. Phone/Fax

Practice location:
  • Phone: 864-587-9872
  • Fax: 864-587-9892
Mailing address:
  • Phone: 864-587-9872
  • Fax: 864-587-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number16260
License Number StateSC

VIII. Authorized Official

Name: DR. MARY M VARN
Title or Position: OWNER
Credential: MD
Phone: 864-587-9872