Provider Demographics
NPI:1558365346
Name:HUSSEY, RICHARD HENRY III (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HENRY
Last Name:HUSSEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1275 21ST AVE N BLDG 2
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-7514
Mailing Address - Country:US
Mailing Address - Phone:843-449-9140
Mailing Address - Fax:843-497-5110
Practice Address - Street 1:1275 21ST AVE N BLDG 2
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-7514
Practice Address - Country:US
Practice Address - Phone:843-449-9140
Practice Address - Fax:843-497-5110
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19296207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC203655134OtherTAX ID
SCGP4300Medicaid
SC8383Medicare PIN
SCGP4300Medicaid