Healthcare Provider Details

I. General information

NPI: 1982608469
Provider Name (Legal Business Name): MUKESH M GANDHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E GEORGIA ST
WOODRUFF SC
29388-1915
US

IV. Provider business mailing address

409 E GEORGIA ST
WOODRUFF SC
29388-1915
US

V. Phone/Fax

Practice location:
  • Phone: 864-476-7068
  • Fax: 864-476-7069
Mailing address:
  • Phone: 864-476-7068
  • Fax: 864-476-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14842
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: