Provider Demographics
NPI:1073931739
Name:DAMON, DARRYL
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:
Last Name:DAMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-6521
Mailing Address - Country:US
Mailing Address - Phone:843-439-4003
Mailing Address - Fax:
Practice Address - Street 1:2230 HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-6521
Practice Address - Country:US
Practice Address - Phone:843-439-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)