Basic Information
| Provider Information | |||||||||
| NPI: | 1437339959 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAUNDERS | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1831 W EVANS ST | ||||||||
| Address2: | STE 315 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295013300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819173977 | ||||||||
| FaxNumber: | 8325537783 | ||||||||
| Practice Location | |||||||||
| Address1: | 8002 MYRTLE TRACE DR | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295268945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433477227 | ||||||||
| FaxNumber: | 8433477232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2007 | ||||||||
| LastUpdateDate: | 08/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 120327 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP4505 | 05 | SC | MEDICAID | 120327 | 05 | SC | MEDICAID | PA8688 | 05 | SC | MEDICAID |