Healthcare Provider Details

I. General information

NPI: 1780697151
Provider Name (Legal Business Name): JAMES MARVIN VEST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 HIGHWAY 17 N
SURFSIDE BEACH SC
29575-6012
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTENTION PATIENT ACCOUNTING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-238-5654
  • Fax: 843-238-1624
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13280
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: