Provider Demographics
NPI:1073132908
Name:HORAWSKI, JENNIFER LYDIA (MD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYDIA
Last Name:HORAWSKI
Suffix:
Gender:F
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:GRAND STRAND MEDICAL CENTER-GME OFFICE
Mailing Address - Street 2:809 82ND PARKWAY
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572
Mailing Address - Country:US
Mailing Address - Phone:843-848-4640
Mailing Address - Fax:843-839-2382
Practice Address - Street 1:GRAND STRAND MEDICAL CENTER-GME OFFICE
Practice Address - Street 2:809 82ND PARKWAY
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572
Practice Address - Country:US
Practice Address - Phone:843-848-4640
Practice Address - Fax:843-839-2382
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2022-01-25
Deactivation Date:2022-01-10
Deactivation Code:
Reactivation Date:2022-01-25
Provider Licenses
StateLicense IDTaxonomies
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program