Provider Demographics
NPI:1710959242
Name:ATWOOD, GERALD F (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:F
Last Name:ATWOOD
Suffix:
Gender:M
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7132
Mailing Address - Fax:843-777-4487
Practice Address - Street 1:901 E CHEVES ST
Practice Address - Street 2:SUITE 400
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2716
Practice Address - Country:US
Practice Address - Phone:843-777-7300
Practice Address - Fax:843-777-7311
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC160772080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC160774Medicaid
SCD257368552Medicare ID - Type Unspecified
SC160774Medicaid