Provider Demographics
NPI:1366407231
Name:F. MARION DWIGHT, MD,PA
Entity type:Organization
Organization Name:F. MARION DWIGHT, MD,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCALHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-245-5168
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-0120
Mailing Address - Country:US
Mailing Address - Phone:803-245-5168
Mailing Address - Fax:803-245-6275
Practice Address - Street 1:2113 MAIN HWY
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-2705
Practice Address - Country:US
Practice Address - Phone:803-245-5168
Practice Address - Fax:803-245-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0698Medicaid
SC2056Medicare PIN