Provider Demographics
NPI:1518306059
Name:MCDOWELL, MISTY LEE (MD)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:LEE
Last Name:MCDOWELL
Suffix:
Gender:F
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 1:853 N CHURCH ST STE 610
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3070
Practice Address - Country:US
Practice Address - Phone:864-560-1600
Practice Address - Fax:864-560-1669
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35722207V00000X, 207VM0101X
IN01078290A207V00000X
SCLL35772207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC357722Medicaid
SCSCI2894746OtherMEDICARE PIN
IN01078290AOtherMEDICAL LICENSE