Provider Demographics
NPI:1184621443
Name:AUSTIN, TIMOTHY L (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:AUSTIN
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 369
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-0369
Mailing Address - Country:US
Mailing Address - Phone:864-227-2020
Mailing Address - Fax:864-227-2823
Practice Address - Street 1:665 WEST ALEXANDER ROAD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-227-2020
Practice Address - Fax:864-227-2823
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27646207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00223967OtherRAILROAD MEDICARE
SCCE6166OtherRAILROAD MEDICARE GROUP
SCPA0515Medicaid
SC276463Medicaid
SC1558Medicare PIN
SCP00223967OtherRAILROAD MEDICARE
SC0312620001Medicare NSC
SCAA08291558Medicare PIN