Provider Demographics
NPI:1912912130
Name:CAMDEN GENERAL AND VASCULAR SURGERY
Entity Type:Organization
Organization Name:CAMDEN GENERAL AND VASCULAR SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-432-8989
Mailing Address - Street 1:1001 FAIRLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4525
Mailing Address - Country:US
Mailing Address - Phone:803-432-8989
Mailing Address - Fax:
Practice Address - Street 1:1001 FAIRLAWN DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4525
Practice Address - Country:US
Practice Address - Phone:803-432-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16224207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4285Medicaid
SCTL9141Medicaid
SCC70622Medicare UPIN
SCTL9141Medicaid