Provider Demographics
NPI:1891738423
Name:WALSH, STANLEY G (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:G
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22580 HIGHWAY 76 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-8439
Mailing Address - Country:US
Mailing Address - Phone:864-833-5986
Mailing Address - Fax:864-833-0599
Practice Address - Street 1:22580 HIGHWAY 76 E
Practice Address - Street 2:SUITE 100
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-8439
Practice Address - Country:US
Practice Address - Phone:864-833-5986
Practice Address - Fax:864-833-0599
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC23601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC236015Medicaid
SC236015Medicaid
SCH778188536Medicare PIN