Provider Demographics
NPI:1508492315
Name:DENMARK, ETHEL B
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:B
Last Name:DENMARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2605
Mailing Address - Country:US
Mailing Address - Phone:843-987-7400
Mailing Address - Fax:
Practice Address - Street 1:211 PAIGE POINT RD.
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:SC
Practice Address - Zip Code:29941
Practice Address - Country:US
Practice Address - Phone:843-846-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist