Provider Demographics
NPI:1952497653
Name:DEWITT, JOHN HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOWARD
Last Name:DEWITT
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 1:33 VARDEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803
Mailing Address - Country:US
Mailing Address - Phone:803-642-3801
Mailing Address - Fax:803-642-5538
Practice Address - Street 1:33 VARDEN DRIVE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803
Practice Address - Country:US
Practice Address - Phone:803-642-3801
Practice Address - Fax:803-642-5538
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC133342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC133340Medicaid
SC260027817OtherRR MEDICARE ID
SC260027817OtherRR MEDICARE ID
SCB91696Medicare UPIN