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General NPI Number Information
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NPI Number | 1477511053
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Entity Type | Individual
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Provider Name | MARTIN D CARMICHAEL MD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 51 ELEVENTH AVENUE
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City | AYNOR
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State | SC
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Zip | 29511-3942
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Country | US
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Telephone | 843-358-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 300 SINGLETON RIDGE RD
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City | CONWAY
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State | SC
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Zip | 29526-9142
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Country | US
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Telephone | 843-234-6827
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Fax | 843-234-6990
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12073
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License Number State | SC
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