Provider Demographics
NPI:1225166044
Name:CONYERS, RODNEY R
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:R
Last Name:CONYERS
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 1:1081 OSWEGO HWY
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-8734
Mailing Address - Country:US
Mailing Address - Phone:803-896-1258
Mailing Address - Fax:
Practice Address - Street 1:4450 BROADRIVER RD.
Practice Address - Street 2:DEPT. OF CORRECTIONS
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-896-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health