Individual
CORNELL CAVINESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
1075 N FRASER ST, GEORGETOWN, SC 29440-2848
(843) 527-3588
Mailing address
1075 N FRASER ST, GEORGETOWN, SC 29440-2848
(843) 527-3588
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A342
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1371
—
SC
05
—
RHC168
—
SC
Enumeration date
01/18/2007
Last updated
12/29/2011
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