Provider Demographics
NPI:1063486751
Name:GIVENS, RONNIE M II (MD)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:M
Last Name:GIVENS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 SPRINGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8154
Mailing Address - Country:US
Mailing Address - Phone:843-797-3664
Mailing Address - Fax:843-820-1007
Practice Address - Street 1:83 SPRINGVIEW LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8154
Practice Address - Country:US
Practice Address - Phone:843-797-3664
Practice Address - Fax:843-820-1007
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20824207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC208242Medicaid
SCG93624Medicare UPIN
SC208242Medicaid