Individual
MICHAEL DOUGLAS MAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
233 MOUNTAIN ESTATES RD, PICKENS, SC 29671-8518
(864) 637-8770
Mailing address
233 MOUNTAIN ESTATES RD, PICKENS, SC 29671-8518
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
04/25/2018
Last updated
04/25/2018
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