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General NPI Number Information
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NPI Number | 1750471967
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Entity Type | Individual
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Provider Name | KEITH S. ROCKWILEY PA
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 301 E JACKSON ST EMERGENCY DEPT.
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City | DILLON
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State | SC
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Zip | 29536-2509
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Country | US
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Telephone | 843-774-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 2849 DOGWOOD RD
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City | TIMMONSVILLE
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State | SC
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Zip | 29161-8614
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Country | US
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Telephone | 843-346-1035
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0002414
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License Number State | MD
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