Healthcare Provider Details

I. General information

NPI: 1649290362
Provider Name (Legal Business Name): DAVID A JUSTICE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 N LAFAYETTE DR
SUMTER SC
29150-2964
US

IV. Provider business mailing address

1278 N LAFAYETTE DR
SUMTER SC
29150-2964
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-4500
  • Fax:
Mailing address:
  • Phone: 803-774-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16179
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16179
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: