Provider Demographics
NPI:1619932712
Name:HARVEY, MACK CARLTON (ATC)
Entity Type:Individual
Prefix:MR
First Name:MACK
Middle Name:CARLTON
Last Name:HARVEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BAMBOO GROVE CT
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-7523
Mailing Address - Country:US
Mailing Address - Phone:803-781-9149
Mailing Address - Fax:
Practice Address - Street 1:1400 OLD TAMAH RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9799
Practice Address - Country:US
Practice Address - Phone:803-732-8055
Practice Address - Fax:803-732-8064
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer