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General NPI Number Information
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NPI Number | 1063081081
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Entity Type | Individual
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Provider Name | DR. PEYTON MCELVEEN HERNDON
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Gender | Female
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 1 WINCHESTER CT
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City | MAULDIN
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State | SC
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Zip | 29662-2626
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Country | US
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Telephone | 864-234-5515
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Fax | 509-357-8217
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Provider Business Mailing Address
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Address Line | 400 MEMORIAL DRIVE EXT STE 400
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City | GREER
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State | SC
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Zip | 29651-1850
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Country | US
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Telephone | 864-282-1935
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Fax | 864-751-6387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9921
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License Number State | SC
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