Provider Demographics
NPI:1568437184
Name:OVERTON, MARK HOWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:HOWARD
Last Name:OVERTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4237 RIVER HILLS DRIVE, SUITE 150
Mailing Address - Street 2:RIVER HILLS MEDICAL PLAZA
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-6444
Mailing Address - Country:US
Mailing Address - Phone:843-281-2778
Mailing Address - Fax:843-281-2785
Practice Address - Street 1:4237 RIVER HILLS DRIVE, SUITE 150
Practice Address - Street 2:RIVER HILLS MEDICAL PLAZA
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6444
Practice Address - Country:US
Practice Address - Phone:843-281-2778
Practice Address - Fax:843-281-2785
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC32215207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA47607730Medicare Oscar/Certification
SCC85858Medicare UPIN
PA732408JJFMedicare ID - Type Unspecified
PAC85858Medicare UPIN