Basic Information
Provider Information | |||||||||
NPI: | 1912168378 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCCLARY | ||||||||
FirstName: | GUY | ||||||||
MiddleName: | ELTON | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3239 | ||||||||
Address2: |   | ||||||||
City: | FLORENCE | ||||||||
State: | SC | ||||||||
PostalCode: | 295023239 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8437777042 | ||||||||
FaxNumber: | 8437777102 | ||||||||
Practice Location | |||||||||
Address1: | 800 E CHEVES ST | ||||||||
Address2: | SUITE 310 | ||||||||
City: | FLORENCE | ||||||||
State: | SC | ||||||||
PostalCode: | 295062650 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8436797272 | ||||||||
FaxNumber: | 8436797215 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/18/2008 | ||||||||
LastUpdateDate: | 02/12/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/12/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30969 | SC | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 309696 | 05 | SC |   | MEDICAID | 3774703 | 01 | SC | CIGNA | OTHER | AA64128552 | 01 | SC | MEDICARE PTAN | OTHER | 9846723 | 01 | SC | AETNA | OTHER | P00995697 | 01 | SC | RAILROAD MEDICARE | OTHER |