Provider Demographics
NPI:1356489579
Name:FLOYD, HARRY WELLS (MD)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:WELLS
Last Name:FLOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 THURGOOD MARSHALL BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556
Mailing Address - Country:US
Mailing Address - Phone:843-355-7461
Mailing Address - Fax:843-355-3616
Practice Address - Street 1:500 THURGOOD MARSHALL BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556
Practice Address - Country:US
Practice Address - Phone:843-355-7461
Practice Address - Fax:843-355-3616
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC5526208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC055264Medicaid
SCPA7215Medicaid
TNRHC103Medicaid
TNRHC103Medicaid
C60527Medicare UPIN