Individual
PICKENS MOYD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
737 S MAIN ST, SOCIETY HILL, SC 29593-8972
(843) 378-4501
Mailing address
737 S MAIN ST, SOCIETY HILL, SC 29593-8972
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12990
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129907
—
SC
01
—
P00124099
RAILROAD MEDICARE PTAN
SC
Enumeration date
08/19/2006
Last updated
09/01/2017
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