Provider Demographics
NPI:1184804536
Name:NAZON, HEROLD (MD)
Entity type:Individual
Prefix:DR
First Name:HEROLD
Middle Name:
Last Name:NAZON
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 749306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9306
Mailing Address - Country:US
Mailing Address - Phone:843-871-3277
Mailing Address - Fax:843-871-3360
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6420
Practice Address - Country:US
Practice Address - Phone:843-871-3277
Practice Address - Fax:843-871-3360
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC12512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2608Medicaid
SCGP2608Medicaid
SC0281Medicare PIN