=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154208635
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET MAYLON BOVARD PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 ACADEMY AVE
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-223-8090
-----------------------------------------------------
Fax | 864-223-4026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 S ADAIR ST
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29325-2566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-456-2360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 6119
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------