Provider Demographics
NPI:1770556169
Name:EMERSON, GARY H (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:H
Last Name:EMERSON
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-656-2223
Mailing Address - Fax:843-656-2242
Practice Address - Street 1:101 WILLIAM H. JOHNSON STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2772
Practice Address - Country:US
Practice Address - Phone:843-777-7400
Practice Address - Fax:843-777-7440
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23253207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC232536Medicaid
NC89065VYOtherNC MEDICAID
SCG97886Medicare UPIN
SCG978868552Medicare ID - Type Unspecified