Provider Demographics
NPI:1639187123
Name:EWENS, JOSEPH DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:EWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:D
Other - Last Name:EWENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1203 OLD TROLLEY RD
Mailing Address - Street 2:STE F
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5296
Mailing Address - Country:US
Mailing Address - Phone:843-486-0999
Mailing Address - Fax:843-486-0989
Practice Address - Street 1:1203 OLD TROLLEY RD
Practice Address - Street 2:STE F
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5296
Practice Address - Country:US
Practice Address - Phone:843-486-0999
Practice Address - Fax:843-486-0989
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2845Medicaid
SCGP2845Medicaid