Provider Demographics
NPI:1881644557
Name:HORRY, MALCOLM H (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:H
Last Name:HORRY
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 1:595 W CAROLINA AVE
Mailing Address - Street 2:PO BOX 338
Mailing Address - City:VARNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29944-4735
Mailing Address - Country:US
Mailing Address - Phone:803-943-7612
Mailing Address - Fax:803-943-7613
Practice Address - Street 1:595 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944-4735
Practice Address - Country:US
Practice Address - Phone:803-943-7612
Practice Address - Fax:803-943-7613
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL5264Medicaid
SCF94520Medicare UPIN
SCTL5264Medicaid