Individual
DR. CHANNING DALE WILLOUGHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4040 HIGHWAY 17, SUITE206, MURRELLS INLET, SC 29576-5098
(843) 652-8260
(843) 652-8269
Mailing address
PO BOX 421718, GEORGETOWN, SC 29442-4203
(843) 652-8226
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
33509
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33509
STATE MEDICAL LICENSE
SC
Enumeration date
06/29/2007
Last updated
03/18/2021
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