Individual
MR. JAMES ROBERT MYNATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
333 REVOLUTIONARY TRAIL, FAIRFAX, SC 29827
(803) 632-2533
(803) 632-2451
Mailing address
86 WREN ST, BARNWELL, SC 29812
(803) 259-5762
(803) 259-3250
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F1512
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1512
MEDICAL LICENSE
SC
05
—
NP0589
—
SC
Enumeration date
10/02/2008
Last updated
01/11/2024
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