Healthcare Provider Details

I. General information

NPI: 1881644557
Provider Name (Legal Business Name): MALCOLM H HORRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W CAROLINA AVE
VARNVILLE SC
29944-4735
US

IV. Provider business mailing address

595 W CAROLINA AVE PO BOX 338
VARNVILLE SC
29944-4735
US

V. Phone/Fax

Practice location:
  • Phone: 803-943-7612
  • Fax: 803-943-7613
Mailing address:
  • Phone: 803-943-7612
  • Fax: 803-943-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14765
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: