Provider Demographics
NPI:1821689597
Name:WINDHAM, NEIL HOWELL III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:HOWELL
Last Name:WINDHAM
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:WINDHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:SC HOUSE CALLS INC.
Mailing Address - Street 2:206 SWIFT CREEK RD.
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:
Practice Address - Street 1:SC HOUSE CALLS INC.
Practice Address - Street 2:111 DOCTORS CIR.
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC4260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4260OtherMEDICAL LICENSE