Provider Demographics
NPI:1518172972
Name:BIRCHENOUGH, SHAWN A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:A
Last Name:BIRCHENOUGH
Suffix:
Gender:M
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:391 SERPENTINE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3096
Practice Address - Country:US
Practice Address - Phone:864-560-6717
Practice Address - Fax:864-560-7105
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31645208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918104Medicaid
SC316456Medicaid
SC316456Medicaid